The Texas Health and Human Services Commission (HHSC) proposes an amendment to Title 1, Part 15, Subchapter J, Division 4, §355.8052, concerning Inpatient Hospital Reimbursement. The amendment updates the Medicaid inpatient hospital reimbursement methodology.
The proposed rule complies with the 2010-11 General Appropriations Act (Article II, HHSC, Rider 68, S.B. 1, 81st Legislature, Regular Session, 2009), which requires HHSC to rebase acute care hospital rates within available funds (at no additional cost). Specifically, the legislation requires HHSC to update the payment division standard dollar amounts (PDSDAs) and diagnosis related group (DRG) factors with more recent cost data. Rider 68 further instructs HHSC to proportionately reduce the rebased PDSDA rates to remain within available funds. The current rules were amended and adopted on August 9, 2010 to include these legislative provisions.
The PDSDA is a component of the Medicaid inpatient reimbursement formula for hospitals. The PDSDA is the weighted average dollar amount per claim calculated for all hospitals in a payment division, which is a grouping of hospital-specific standard dollar amounts (HSDAs). The HSDA is based on each hospital’s average cost per claim for a designated base year, adjusted by the hospital’s case mix index and a cost-of-living index.
HHSC was scheduled to implement the rebased PDSDA rates for services provided effective September 1, 2010, however the rebased rates would have resulted in some hospitals’ SDA payments decreasing and some hospitals’ SDA payments increasing, thus having positive and negative fiscal impacts. HHSC received feedback that hospitals were concerned about the substantial financial impact to their hospital as well as other hospitals in their geographic region if the proportional rebasing were implemented. HHSC is concerned that the implementation of the proportional rebased SDAs would have unintended negative consequences to the future provision of inpatient services in the state. As a result, an amendment to this rule is being proposed which will develop new SDAs that would mitigate the loss of revenues to impacted hospitals to 10 percent of their estimated loss. In order to achieve the no-cost provision of Rider 68, the rule also outlines an adjustment of the proportional rebased SDAs to limit the amount of revenue gained by positively impacted hospitals.
The earliest possible date of adoption is October 10, 2010.
For more details, please visit: http://www.sos.state.tx.us/texreg/archive/September102010/PROPOSED/1.ADMINISTRATION.html#5