Texas Register, Volume 38, Number 36, Pages 5801-5944, September 6, 2013 Page: 5,869
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subsection or the sum of remaining qualifying hospitals' interim hospi-
tal-specific limits.
(h) DSH payment calculation.
(1) Data verification. HHSC uses the methodology de-
scribed in 355.8066(d) of this title to verify the data used for the DSH
payment calculations described in this subsection. The verification
process includes:
(A) notice to hospitals of the data provided to HHSC by
Medicaid contractors; and
(B) an opportunity for hospitals to request HHSC re-
view of disputed data.
(2) Allocation of available DSH funds by category of hos-
pital. From the amount of remaining available DSH funds determined
in subsection (g)(2) of this section, HHSC will establish a pool amount
for DSH payments to each of the following categories of hospital:
(A) Pool One is comprised of urban public hospitals -
class two and all hospitals in an RHP area with an urban public hospital
- class one. The Pool One amount is equal to that portion of the amount
of remaining available DSH funds determined in subsection (g)(2) of
this section where the non-federal share of funding for hospitals in an
RHP area with an urban public hospital - class one comes from in-
tergovernmental transfers from the governmental entities that own an
urban public hospital - class one as defined in subsection (b)(44) of this
section and the non-federal share of funding for each of the urban pub-
lic hospitals - class two comes from intergovernmental transfers from
the governmental entity that owns the urban public hospital - class two
as defined in subsection (b)(45) of this section.
(B) Pool Two is comprised of hospitals in RHP areas
without an urban public hospital and non-urban public hospitals in RHP
areas with an urban public hospital - class two. The Pool Two amount
is equal to that portion of the amount of remaining available DSH funds
determined in subsection (g)(2) of this section where the non-federal
share of funding comes from a source other than intergovernmental
transfers from a governmental entity that owns an urban public hospital.
(3) Weighting factors.
(A) HHSC will assign each urban public hospital a
weighting factor based on its RHP area as follows:
(i) RHP Area 3 Urban Public Hospital Weighting
Factor is 3.3672.
(ii) RHP Area 6 Urban Public Hospital Weighting
Factor is 4.0481.
(iii) RHP Area 7 Urban Public Hospital Weighting
Factor is 3.3375.
(iv) RHP Area 9 Urban Public Hospital Weighting
Factor is 2.3624.
(v) RHP Area 10 Urban Public Hospital Weighting
Factor is 2.4542.
(vi) RHP Area 12 Urban Public Hospital Weighting
Factor is 1.6271.
(vii) RHP Area 14 Urban Public Hospital Weighting
Factor is 1.6347.
(viii) RHP Area 15 Urban Public Hospital Weight-
ing Factor is 3.2453.(B) All other DSH hospitals not described in subpara-
graph (A) of this paragraph will be assigned a weighting factor of
1.0000.
(C) HHSC may change the weighting factors as needed
in the DSH program to address changes in program size including
changes in the hospital-specific limits of one or more hospitals.
(4) Distribution and payment calculation.
(A) For each category of hospital described in para-
graph (2)(A) and (B) of this subsection, HHSC will divide the amount
of the associated pool into two equal parts:
(i) One half of the funds will reimburse each hospi-
tal in that category based on its percentage of the aggregate weighted
Medicaid inpatient days for all hospitals in that category.
(ii) One half of the funds will reimburse each hospi-
tal in that category based on its percentage of the aggregate weighted
low-income days for all hospitals in that category.
(B) HHSC will calculate each hospital's total weighted
Medicaid inpatient days and total weighted low-income days as fol-
lows.
(i) Weighted Medicaid inpatient days are equal to
the hospital's Medicaid inpatient days multiplied by the appropriate
weighting factor from paragraph (3) of this subsection.
(ii) Weighted low-income days are equal to the hos-
pital's low-income days multiplied by the appropriate weighting factor
from paragraph (3) of this subsection.
(C) Using the results in subparagraph (B) of this para-
graph, HHSC will:
(i) divide each hospital's total weighted Medicaid in-
patient days by the sum of weighted Medicaid inpatient days for all
hospitals in the same category to obtain a percentage;
(ii) multiply each hospital's percentage calculated in
clause (i) of this subparagraph by the amount determined in subpara-
graph (A)(i) of this paragraph;
(iii) divide each hospital's total weighted low-in-
come days by the sum of weighted low-income days for all hospitals
in the same category to obtain a percentage;
(iv) multiply each hospital's percentage calculated in
clause (iii) of this subparagraph by the amount determined in subpara-
graph (A)(ii) of this paragraph; and
(v) sum the results of clauses (ii) and (iv) of this sub-
paragraph to determine each hospital's projected payment amount.
(I) The projected payment amount may not ex-
ceed a hospital's interim hospital-specific limit.
(II) Any amount above a hospital's interim hos-
pital-specific limit will be redistributed to other hospitals as described
in paragraph (5) of this subsection.
(5) Redistribution of amounts in excess of hospital-specific
limits. In the event that the projected payment amount calculated in
paragraph (4) of this subsection plus any previous payment amounts
for the program year exceeds a hospital's interim hospital-specific limit,
the payment amount will be reduced to the interim hospital-specific
limit. For each category of hospital described in paragraph (2) of this
subsection, HHSC will separately sum all resulting excess funds and
redistribute that amount to qualifying hospitals in that category that
have projected payments, including any previous payment amounts forADOPTED RULES September 6, 2013 38 TexReg 5869
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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/m1/69/: accessed March 28, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.