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Below is the HillCo client report from the June 13 Hospital Payment Advisory Committee meeting.
 
HPAC met to discuss disproportionate share hospital reimbursement methodology and waiver payments.
 
Health and Human Services Commission (HHSC) proposes to amend Title 1, Part 15, Chapter 355, §355.8065, concerning Disproportionate Share Hospital Reimbursement Methodology; §355.8201, Waiver Payments to Hospitals for Uncompensated Care; §355.8202, Waiver Payments to Physician Group Practices for Uncompensated Care; and §355.8441, Reimbursement Methodologies for Early and Periodic Screening, Diagnosis, and Treatment.

The proposed amendments are intended to meet the requirements of 2014-15 General Appropriations Act, Senate Bill 1, 83rd Legislature, Regular Session, 2013 (Article II, HHSC, Rider 86, Transitional Medicaid Disproportionate Share Hospital and Related Payments), which allows HHSC to expend up to $160 million in general revenue funds in fiscal year 2014 and $140 million in general revenue funds in fiscal year 2015 to stabilize and improve Medicaid hospital payments.  Changes are proposed to both the disproportionate share hospital and uncompensated care (UC) supplemental payment programs. 

The proposed amendments to the disproportionate share hospital and UC supplemental payment program revise the way that the state's disproportionate share hospital allocation is distributed among eligible hospitals and the way that the state's UC allocation is distributed among eligible provider.

Trisha Young, Central Health

  • One of the 6 transferring entities for the state
  • Concerned that this rule doesn’t find a sustainable method
  • Serious implications for transferring entities
  • Have made some steps in the right directions in DSH
  • Have agreed to increase IGTs to fund the DSH program fully
  • The credit doesn’t reflect the total IGT put up by the transferring hospitals
  • Creates winners and losers
  • Publics are seeing a decrease in 42M in net IGT
  • Privates are seeing a net increase
  • Have a proposal to help make the system more equitable
  • Compromise needs to be based on sound policy
  • Timothy McVey – intrigued by the notion that everyone can come out ahead – has it been submitted to HHSC?
    • Yes, it is very technical, uses historical allocation and tries to correct imbalances on the UC side

David Lopez, Harris Health System

  • Wants to get full credit for IGT
  • Agrees with comments made by Central Health
  • Pharmaceutical and outpatient costs should be used in calculation for UC
  • Takes them from braking even to a 25M reduction
  • Can no longer be penalized for providing IGT

Fred Cerise, Parkland CEO

  • Agrees with all previous comments
  • This penalizes the large public hospitals
  • Wants decisions based on sound public policy
  • Of the 378M they spend they would be credited 283M

George Hernandez, University Health System

  • Echoes previous comment
  • UC cap and pool allocations need to be based on solid policy, and it shouldn’t be radical
  • Need to stick with current UC methodology
  • Looking for burden alleviation with community partners to serve UC, but this makes the burden much more significant

Michael Nunoz – El Paso Health Care District

  • Agrees with previous partners
  • Have good relationship with private partners in the community
  • Need long term sustainability

Maureen Milligan, THOT

  • Represent large public urban hospitals
  • Believes this rule is contrary to the intent of Rider 86
  • Need to take into account outpatient UC
  • Rider 86 instructs that it must ensure the sustainability of the program IGT

John Berta – THA

  • Asked Pam McDonald to discuss the 10% held back in FY 2013 for DSH
    • 10% withheld because of a lawsuit that is now resolved
    • Waiting for a State Plan Amendment from CMS that was tied to the litigation that would exclude 3rd party payments
    • CMS has verbally told HHSC that they would deny the amendment, but HHSC is holding onto the money until they get final notice which is expected in July
      • Will have to make a decision if HHSC wants to appeal CMS’s decision
      • Then the commission will have to decide if they want to push out 10% or not

HHSC Staff Updates

  • DY 2 UC payments are going out now
  • DSRIP will be paid in July
  • August is the FY closeout
  • September ½ of 2014 DSH will be paid
  • October ½ of 2014 UC will be paid
  • The remainder of 2014 DSH payments are expected in May
  • HHSC is finalizing a timeline through 2016 which they hope to distribute to stakeholders by the end of the month
  • 2012 recoup of DSH and redistribution
    • Currently performing audit of the 2011 payments
    • The report is due in December
    • Next year there will be a recoupment
    • HHSC needs to establish an appeal process
    • Federal regulations state that once overpayments are identified the monies have to be paid back to the federal government or be redistributed within 12 months
  • Waiver renewal
    • Next march HHSC will submit a plan for what Texas would do if the waiver was not renewed
    • September would be the renewal month
    • CMS is hesitant with UC payments going forward, it will be a challenge to maintain them
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