Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 13 - HEALTH PLANNING AND RESOURCE DEVELOPMENT › Subchapter B - DATA COLLECTION › Section 13.13 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, shall have the following meanings, unless the context clearly
					 indicates otherwise.
(1) Chapter
				  104--Provisions relating to the data collection responsibilities of the
				  Department of State Health Services as the state health planning and
				  development agency found within the Health and Safety Code, Title 2.
(2) Chapter 311--Provisions relating to the
				  powers and duties of hospitals found within the Health and Safety Code, Title
				  4.
(3) Charity care--The
				  unreimbursed cost to a hospital of providing, funding, or otherwise financially
				  supporting health care services on an inpatient or outpatient basis to a person
				  classified by the hospital as financially or medically indigent and/or
				  providing, funding or otherwise financially supporting health care services
				  provided to financially indigent persons through other nonprofit or public
				  outpatient clinics, hospitals or health care organizations.
(4) Community benefits--The unreimbursed cost
				  to a hospital of providing charity care, government-sponsored indigent health
				  care, donations, education, government-sponsored program services, research,
				  and subsidized health services. Community benefits do not include the cost to
				  the hospital of paying any taxes or other governmental assessments.
(5) Department--The Department of State
				  Health Services.
(6) Donations--The
				  unreimbursed costs of providing cash and in-kind services and gifts, including
				  facilities, equipment, personnel, and programs, to other nonprofit or public
				  outpatient clinics, hospitals, or health care organizations.
(7) Education-related cost--The unreimbursed
				  cost to a hospital of providing, funding, or otherwise financially supporting
				  educational benefits, services, and programs including education of medical
				  professionals and health care providers; scholarships and funding to medical
				  schools, colleges, and universities for health professions education; education
				  of patients concerning diseases and home care in response to community needs;
				  and community health education through informational programs, publications,
				  and outreach activities in response to community needs.
(8) Financially indigent--An uninsured or
				  underinsured person who is accepted for care with no obligation or a discounted
				  obligation to pay for the services rendered based on the hospital's eligibility
				  system.
(9) Government sponsored
				  indigent health care--The unreimbursed cost to a hospital of providing health
				  care services to recipients of Medicaid and other federal, state, or local
				  indigent health care programs, eligibility for which is based on financial
				  need.
(10) Government-sponsored
				  program unreimbursed costs--The unreimbursed cost to the hospital of providing
				  health care services to the beneficiaries of Medicare, the Civilian Health and
				  Medical Program of the Uniformed Services, and other federal, state, or local
				  government health care programs.
(11) Health care facility--Regardless of
				  ownership, a public or private hospital, skilled nursing facility, intermediate
				  care facility, ambulatory surgical facility, family planning clinic which
				  performs ambulatory surgical procedures, rural health initiative clinic, urban
				  health initiative clinic, kidney disease treatment facility, inpatient
				  rehabilitation facility, and other facilities as defined by federal law, but
				  does not include the office of physicians or practitioners of the healing arts
				  singly or in groups in the conduct of their profession.
(12) Health care organization--A nonprofit or
				  public organization that provides, funds, or otherwise financially supports
				  health care services provided to financially indigent persons.
(13) Hospital--A general or special hospital
				  licensed under the Health and Safety Code, Chapter 241; a private mental
				  hospital licensed under the Health and Safety Code, Chapter 577; and a
				  treatment facility licensed under the Health and Safety Code, Chapter
				  464.
(14) Hospital eligibility
				  system--The financial criteria and procedure used by a hospital to determine if
				  a patient is eligible for charity care. The system shall include income levels
				  and means testing indexed to the federal poverty guidelines; provided, however,
				  that a hospital may not establish an eligibility system which sets the income
				  level eligible for charity care lower than that required by counties under
				  §61.023 or higher, in the case of the financially indigent, than 200% of
				  the federal poverty guidelines. A hospital may determine that a person is
				  financially or medically indigent pursuant to the hospital's eligibility system
				  after health care services are provided.
(15) Hospital system--A system of local
				  nonprofit hospitals under the common governance of a single corporate parent
				  that are located within a radius of not more than 125 linear miles of the
				  corporate parent.
(16) Medically
				  indigent--A person whose medical or hospital bills after payment by third-party
				  payors exceed a specified percentage of the patient's annual gross income,
				  determined in accordance with the hospital's eligibility system, and the person
				  is financially unable to pay the remaining bill.
(17) Net patient revenue--An accounting term
				  that shall be calculated in accordance with generally accepted accounting
				  principles for hospitals.
(18)
				  Nonprofit hospital--
(A) A hospital that is
				  organized as a nonprofit corporation or a charitable trust under the laws of
				  this state or any other state or country and is:
(i) eligible for tax-exempt bond financing;
				  or
(ii) exempt from state
				  franchise, sales, ad valorem, or other state or local taxes. For purposes of
				  determining whether a hospital is "organized" as a nonprofit corporation or
				  charitable trust, the department will look at the entity which holds the
				  hospital license issued by the department; that is the entity which must be
				  organized as a nonprofit corporation or charitable trust.