Texas Register, Volume 38, Number 36, Pages 5801-5944, September 6, 2013 Page: 5,862
5801-5944 p. ; 28 cm.View a full description of this periodical.
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the Centers for Medicare and Medicaid Services. Use of an allo-
cation methodology that is not acceptable to CMS could put the
entire federal share of Texas' DSH allocation at risk. No changes
were made in response to this comment.
Comment: Concerning 355.8065(h)(3)(C), authorizing HHSC
to change the weighting factors as needed to address changes
in program size, one commenter proposed requiring HHSC to
hold a public hearing prior to implementing any changes in the
weighting factors.
Response: HHSC does not believe that a formal public hearing
is required for this purpose or would be the best way to work
with stakeholders should the weighting factors require updating.
Rather, HHSC believes that any work to revise the weighting
factors would be best conducted through an iterative process
of communication, modeling and sharing of data with affected
stakeholders. No changes were made in response to this com-
ment.
Comment: Concerning 355.8065(h)(4), commenters requested
that the DSH allocation methodology be modified to base the al-
location on a hospital's total uncompensated costs to be consis-
tent with the method for calculating total uncompensated care
costs as set forth in the Section 1115 waiver. According to these
commenters, the proposed rule artificially directs DSH payments
based on low income days and Medicaid inpatient days that don't
reflect actual utilization or costs and makes DSH primarily a Med-
icaid rate subsidy program and the DSH methodology should eq-
uitably pay those providing relatively more services to the unin-
sured.
Response: HHSC respectfully disagrees with these com-
menters. Under the proposed rule, one-half of available funds
is distributed based on Medicaid inpatient days and one half is
distributed based on low income days; such a fifty-fifty split does
not support the commenters' statement that the rule makes
DSH primarily a Medicaid rate subsidy program. The proposed
distribution methodology helps to balance various competing
goals for the DSH program in a way that meets Texas' unique
healthcare funding needs. No changes were made in response
to this comment.
Comment: Concerning 355.8065(h)(4), one commenter stated
that Medicaid DSH payments should be distributed based on
the number of each hospital's low income and Medicaid days as
compared to the total number of low-income and Medicaid days
provided by all hospitals receiving Medicaid DSH payments.
Response: HHSC is unsure of the intent of this commenter. If the
intent is that, within each pool, funding be distributed based on
the number of each hospital's low income and Medicaid days as
compared to the total number of low-income and Medicaid days
provided by all hospitals in the same pool receiving Medicaid
DSH payments, HHSC agrees with this commenter and believes
that its proposed methodology comports with the methodology
proposed in the comment. If the intent of the commenter is that
funding be distributed based on the number of each hospital's
low income and Medicaid days as compared to the total num-
ber of low-income and Medicaid days provided by all hospitals
receiving Medicaid DSH payments, regardless of the hospital's
pool membership, HHSC does not agree with the commenter.
The basis for the two pools is that urban public hospitals' IGTs
should only support payments to hospitals located in an urban
public hospital RHP. The method suggested by the commenter
would result in some urban public hospitals' IGTs supporting pay-ments to hospitals not located in an urban public hospital RHP.
No changes were made in response to this comment.
Additional allocation of DSH funds for rural public hospitals and
rural public-financed hospitals
Comment: Concerning 355.8065(h)(6), one commenter sup-
ports the inclusion of an additional payment to non-public rural
and critical access hospitals to ensure that this group of hospi-
tals does not receive less than the amount that would have been
paid to these hospitals under the existing rule.
Response: HHSC respectfully disagrees with this comment.
Given reductions in Texas' federal medical assistance percent-
age and in the amount of IGT dedicated to this program by the
urban public hospitals, it is not possible to guarantee any subset
of hospitals the same amount of DSH funding it received in
previous DSH program years. HHSC is cognizant of the unique
role of rural and critical access hospitals and will continue
monitoring the health of this subsection of the hospital industry
to ensure adequate access to care in the areas served by these
hospitals. No changes were made in response to this comment.
Medicaid Data Verification
Comment: Concerning 355.8065(h)(1), regarding Medicaid
data verification, commenters requested that HHSC (1) remove
the requirement that hospitals communicate directly with the
Medicaid contractors before the contractors prepare their final
reports; (2) require Medicaid contractors to make their final
reports available to hospitals on or before April 15; and (3) allow
hospitals to submit their own self report of Medicaid data if a
Medicaid contractor does not file a final report by April 15. In
addition the commenters request that HHSC continue to provide
an opportunity to review and work directly with Medicaid con-
tractors to correct errors and discrepancies in the final report of
Medicaid utilization data. The commenters stated that a June 1
deadline for resolving discrepancies would be more appropriate.
Response: Requirements pertaining to data verification have
been deleted from this rule and replaced with references to re-
quirements that will be added to the rule describing the develop-
ment of the hospital-specific limit. The concerns expressed by
these commenters will be addressed in the adoption preamble
for the hospital-specific limit rule when it is adopted. The dele-
tion of these requirements and the addition of references to the
hospital-specific limit rule impacted subsection (h)(1) and sub-
section (j).
Right to Appeal estimated payment amount calculation
Comment: Concerning 355.8065(j), which describes the re-
view process of Husk's determination of eligibility or qualifica-
tion, commenters asked HHSC to remove the proposed changes
and continue the review process that is presently in place. The
commenters stated that hospitals should be entitled to adminis-
trative recourse in the event that HHSC miscalculates payment
amounts which they state frequently occur due to inaccurate data
entry and calculation errors. The commenters also want an op-
portunity to demonstrate errors in data submitted by Medicaid
contractors. Under the proposed rule, commenters state that
they will have no recourse for correcting simple mistakes caused
by human or database configuration errors.
Response: Language concerning errors in data submitted by
Medicaid contractors will be added to the hospital-specific limit
rule upon adoption and comments pertaining to the review of this
data will be addressed in the adoption preamble to that rule. Lan-
guage referring to the hospital-specific limit rule for resolution of38 TexReg 5862 September 6, 2013 Texas Register
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Texas. Secretary of State. Texas Register, Volume 38, Number 36, Pages 5801-5944, September 6, 2013, periodical, September 6, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth342081/m1/62/: accessed April 24, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.