Texas Administrative Code › Title 26 - HEALTH AND HUMAN SERVICES › Part 1 - HEALTH AND HUMAN SERVICES COMMISSION › Chapter 567 - CERTIFICATE OF PUBLIC ADVANTAGE › Subchapter D - RATE REVIEW › Section 567.41 - Rate Reviews for Hospitals Operating Under a Certificate of Public Advantage

Current through Reg. 49, No. 28; July 12, 2024
(a) Texas Health and
				  Safety Code §
										314A.102,
				  requires the Texas Health and Human Services Commission (HHSC) to conduct rate
				  reviews for certain hospitals operating under a Certificate of Public Advantage
				  (COPA).
(b) A hospital operating
				  under a COPA pursuant to Texas Health and Safety Code §
										314A.056 may
				  not change rates for hospital services without prior approval from
				  HHSC.
(c) At least 90 days before
				  the implementation of any proposed change in rates for inpatient or outpatient
				  hospital services and, if applicable, at least 60 days before the execution of
				  a reimbursement agreement with a third-party payor, a hospital operating under
				  a COPA must submit to HHSC:
(1) a completed
				  rate review application as provided by HHSC;
(2) any proposed change in rates for services
				  that meet the definition in 25 TAC §
											133.2 of "inpatient services" or
				  "outpatient services;"
(3) a market
				  analysis of current rates using geographical area;
(4) a capital expenditures requirement
				  beginning with the requested implementation date;
(5) if applicable, any change in
				  reimbursement rates under a reimbursement agreement with a third-party
				  payor;
(6) for an agreement with a
				  third-party payor, other than an agreement described by paragraph (7) of this
				  subsection, or in which rates are set under the Medicare or Medicaid program,
				  information showing:
(A) that the hospital and
				  the third-party payor have agreed to the proposed rates;
(B) whether the proposed rates are less than
				  the corresponding amounts in the producer price index published by the Bureau
				  of Labor Statistics of the United States Department of Labor relating to the
				  hospital services for which the rates are proposed, or a comparable price index
				  chosen by HHSC if the producer price index described by this paragraph is
				  abolished; and
(C) if the proposed
				  rates are above the corresponding amounts in the producer price index, as
				  described by subparagraph (B) of this paragraph, a justification for proposing
				  rates above the corresponding amounts in the producer price index;
(7) to the extent allowed by
				  federal law, for an agreement with a managed care organization that provides or
				  arranges for the provision of health care services under the Medicare or
				  Medicaid program, information showing:
(A)
				  whether the proposed rates are different from rates under an agreement that was
				  in effect before the date the applicable merger agreement took
				  effect;
(B) whether the proposed
				  rates are different from the rates most recently approved by HHSC for the
				  applicable hospital, if HHSC has previously approved rates for the applicable
				  hospital following the issuance of the COPA under this chapter that governs the
				  hospital; and
(C) if the proposed
				  rates exceed rates described by subparagraphs (A) or (B) of this paragraph, a
				  justification for proposing rates in excess of those rates; and
(8) any information concerning
				  costs, patient volume, acuity, payor mix, and other information requested by
				  HHSC.