Texas Register, Volume 38, Number 34, Pages 5371-5484, August 23, 2013 Page: 5,442
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(4) Geographic wage add-on.
(A) Wage index. To determine a children's or urban
hospital's geographic wage add-on, HHSC first calculates a wage in-
dex for Texas as follows:
(i) HHSC identifies the Medicare wage index factor
for each Core Based Statistical Area (CBSA) in Texas.
(ii) HHSC identifies the lowest Medicare wage in-
dex factor in Texas.
(iii) HHSC divides the Medicare wage index factor
for each CBSA by the lowest Medicare wage index factor identified in
clause (ii) of this subparagraph and subtracts one from each resulting
quotient to arrive at a percentage.
(iv) HHSC uses the result of the calculations in
clause (iii) of this subparagraph to calculate each CBSA's add-on
amount described in subparagraph (C) of this paragraph.
(B) County assignment. HHSC will initially assign a
hospital to a CBSA based on the county in which the hospital is lo-
cated. A hospital that has been approved for geographic reclassifica-
tion under Medicare may request that HHSC recognize its Medicare
CBSA reclassification, under the process described in paragraph (8) of
this subsection.
(C) Add-on amount.
(i) HHSC calculates 62 percent of the base SDA to
derive the labor-related portion of that rate, consistent with the Medi-
care labor-related percentage.
(ii) To determine the geographic wage add-on
amount for each CBSA, HHSC multiplies the wage index factor
determined in subparagraph (A)(iv) of this paragraph for that CBSA
by the percentage labor share of the base SDA calculated in clause (i)
of this subparagraph.
(5) Teaching medical education add-on.
(A) Eligibility. A teaching hospital that is a children's
hospital is eligible for the teaching medical education add-on. Each
children's hospital is required to confirm, under the process described
in paragraph (8) of this subsection, that HHSC's determination of the
hospital's eligibility for the add-on is correct.
(B) Add-on amount. HHSC calculates the teaching
medical education add-on amounts as follows:
(i) For each children's hospital, identify the total
hospital medical education cost from each hospital cost report or
reports that cross over the base year.
(ii) For each children's hospital, sum the amounts
identified in clause (i) of this subparagraph to calculate the total medi-
cal education cost.
(iii) For each children's hospital, calculate the aver-
age medical education cost by dividing the amount from clause (ii) of
this subparagraph by the number of cost reports that cross over the base
year.
(iv) Sum the average medical education cost per
hospital to determine a total average medical education cost for all
hospitals.
(v) For each children's hospital, divide the average
medical education cost for the hospital from clause (iii) of this sub-
paragraph by the total average medical education cost for all hospitals
from clause (iv) of this subparagraph to calculate a percentage for the
hospital.(vi) Divide the total average medical education cost
for all hospitals from clause (iv) of this subparagraph by the total base
year cost for all children's hospitals from subsection (c)(1)(B) of this
section to determine the overall teaching percentage of Medicaid cost.
(vii) For each children's hospital, multiply the per-
centage from clause (v) of this subparagraph by the percentage from
clause (vi) of this subparagraph to determine the teaching percentage
for the hospital.
(viii) For each children's hospital, multiply the hos-
pital's teaching percentage by the base SDA amount to determine the
teaching medical education add on amount.
(6) Medical education add-on.
(A) Eligibility. A teaching hospital that is an urban hos-
pital is eligible for the medical education add-on. Each hospital is re-
quired to confirm, under the process described in paragraph (8) of this
subsection, that HHSC's determination of the hospital's eligibility and
Medicare education adjustment factor for the add-on is correct.
(B) Add-on amount. HHSC multiplies the base SDA
by the hospital's Medicare education adjustment factor to determine
the hospital's medical education add-on amount.
(7) Trauma add-on.
(A) Eligibility.
(i) To be eligible for the trauma add-on, a hospital
must be designated as a trauma hospital by the Texas Department of
State Health Services and be eligible to receive an allocation from the
trauma facilities and emergency medical services account under Chap-
ter 780, Health and Safety Code.
(ii) HHSC initially uses the trauma level designation
associated with the physical address of a hospital's TPI. A hospital may
request that HHSC, under the process described in paragraph (8) of
this subsection, use a higher trauma level designation associated with
a physical address other than the hospital's TPI address.
(B) Add-on amount. To determine the trauma add-on
amount, HHSC multiplies the base SDA:designation;
designation;
designation; or
designation.(i) by 12.8 percent for hospitals with Level 1 trauma
(ii) by 8.2 percent for hospitals with Level 2 trauma
(iii) by 1.4 percent for hospitals with Level 3 trauma
(iv) by 0.9 percent for hospitals with Level 4 trauma(C) Reconciliation with other reimbursement for un-
compensated trauma care. Subject to the General Appropriations Act
and other applicable law:
(i) If a hospital's allocation from the trauma facilities
and emergency medical services account administered under Chapter
780, Health and Safety Code, is greater than the total trauma add-on
amount estimated to be paid to the hospital under this section during
the state fiscal year, the Department of State Health Services will pay
the hospital the difference between the two amounts at the time funds
are disbursed from that account to eligible trauma hospitals.
(ii) If a hospital's allocation from the trauma facil-
ities and emergency medical services account is less than the total
trauma add-on amount estimated to be paid to the hospital under this
section during the state fiscal year, the hospital will not receive a pay-38 TexReg 5442 August 23, 2013 Texas Register
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Texas. Secretary of State. Texas Register, Volume 38, Number 34, Pages 5371-5484, August 23, 2013, periodical, August 23, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth342079/m1/72/: accessed April 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.