July 8, 2011
The Texas Health and Human Services Commission (HHSC) proposes to repeal current §355.8052 and replace it with new §355.8052 describing the prospective payment system applicable to Medicaid inpatient hospital payments. The proposed methodology establishes a statewide base standard dollar amount (SDA) that is intended to address the effects of the current hospital-specific rate methodology, which can result in different payments to similarly situated hospitals for the same or similar services. Teaching hospitals and trauma-designated hospitals are eligible for increases to the statewide base SDA, in recognition of the high-cost functions of those groups of providers. Increases to the statewide base SDA are also available based on wage differences related to the geographic area in which each prospectively-paid inpatient hospital is located.
The proposed rule implements the requirements of the 2012-13 General Appropriations Act (Article II, Health and Human Services Commission, H.B. 1, Rider 67 and Rider 61(b)(17), 82nd Legislature, Regular Session, 2011), which direct HHSC to develop a statewide SDA and authorize HHSC to consider high-cost hospital functions and services, including regional differences.
The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on Thursday, July 28, 2011 at 1:30 p.m. to receive public comments on proposed amendments and will also receive public comments on proposed rates developed as a result of these proposed rule amendments. The public hearing will be held in the Lone Star Conference Room of HHSC, Braker Center, Building H, located at 11209 Metric Boulevard, Austin.
To facilitate the transition to a statewide SDA, the Texas Legislature authorized HHSC to use up to $20 million in general revenue funds during the first year that the statewide rate is in effect to mitigate the fiscal impact to hospitals that are disproportionately impacted by the proposed transition to a statewide rate. The proposed rule describes the methodology used to identify the disproportionately impacted hospitals and to mitigate the impact to that group of hospitals.
The Legislature also authorized the transfer of funds to HHSC from the Trauma Facilities and Emergency Medical Services account administered by the Department of State Health Services in order to support the establishment and maintenance of trauma and emergency care facilities across the state by maximizing the availability of federal funds to reimburse trauma hospitals. The proposed methodology assures that reimbursements to a hospital using those funds will not be less than the amount the hospital otherwise would have received for uncompensated trauma care from the Trauma Facilities and Emergency Medical Services account.
HHSC modified the calculation of day and cost outliers by reducing the reimbursement percentage from 70 percent to 60 percent.
The proposed rule also notes that HHSC may, consistent with other administrative rules, adjust rates to accommodate available appropriated funds. HHSC will adjust rates pursuant to this authority to account for the eight percent hospital rate reduction specified in the 2012-13 General Appropriations Act.
HHSC anticipates that the proposed rule will be in effect for inpatient hospital reimbursement only for state fiscal year 2012. HHSC anticipates promulgating a new rule for inpatient reimbursements beginning in state fiscal year 2013, following the next rebasing process and the transition to the all-patient refined diagnosis-related groups.
The proposed rule language and further details can be viewed at: http://www.sos.state.tx.us/texreg/sos/PROPOSED/1.ADMINISTRATION.html#15
