Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 355 - REIMBURSEMENT RATES › Subchapter J - PURCHASED HEALTH SERVICES › Division 11 - TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT › Section 355.8202 - Waiver Payments to Physician Group Practices for Uncompensated Care

Current through Reg. 49, No. 28; July 12, 2024
(a) Introduction. Payments are available
					 under this section for services provided through September 30, 2019, by an
					 eligible physician group practice described in subsection (c) of this section.
					 Waiver payments to physician group practices for uncompensated charity care
					 provided beginning October 1, 2019, are described in §355.8214 of this
					 division (relating to Waiver Payments to Physician Group Practices for
					 Uncompensated Charity Care). Waiver payments to an eligible physician group
					 practice must be in compliance with the Centers for Medicare and Medicaid
					 Services approved waiver Program Funding and Mechanics Protocol, HHSC waiver
					 instructions, and this section.
(b)
					 Definitions.
(1) Aggregate limit--The amount
					 of funds approved by the Centers for Medicare and Medicaid Services for
					 uncompensated-care payments for the demonstration year that is allocated to the
					 physician group practice uncompensated-care pool, as described in §
												RSA
					 355.8201 of this title (relating to Waiver
					 Payments to Hospitals for Uncompensated Care).
(2) Centers for Medicare and Medicaid
					 Services (CMS)--The federal agency within the United States Department of
					 Health and Human Services responsible for overseeing and directing Medicare and
					 Medicaid, or its successor.
(3)
					 Demonstration year--The 12-month period beginning October 1 for which the
					 payments calculated under this section are made. This period corresponds to the
					 Disproportionate Share Hospital program year.
(4) Delivery System Reform Incentive Payments
					 (DSRIP)--Payments related to the development or implementation of a program of
					 activity that supports efforts to enhance access to health care, the quality of
					 care, and the health of patients and families it serves.
(5) Governmental entity--A state agency or a
					 political subdivision of the state. A governmental entity includes a hospital
					 authority, hospital district, city, county, or state entity.
(6) HHSC--The Texas Health and Human Services
					 Commission or its designee.
(7)
					 Intergovernmental transfer (IGT)--A transfer of public funds from a
					 governmental entity to HHSC.
(8)
					 Mid-Level Professional--Medical practitioners which include only these
					 professions: Certified Registered Nurse Anesthetists, Nurse Practitioners,
					 Physician Assistants, Dentists, Certified Nurse Midwives, Clinical Social
					 Workers, Clinical Psychologists, and Optometrists.
(9) Public funds--Funds derived from taxes,
					 assessments, levies, investments, and other public revenues within the sole and
					 unrestricted control of a governmental entity. Public funds do not include
					 gifts, grants, trusts, or donations, the use of which is conditioned on
					 supplying a benefit solely to the donor or grantor of the funds.
(10) Regional Healthcare Partnership (RHP)--A
					 collaboration of interested participants that work collectively to develop and
					 submit to the state a regional plan for health care delivery system reform.
					 Regional Healthcare Partnerships will support coordinated, efficient delivery
					 of quality care and a plan for investments in system transformation that is
					 driven by the needs of local hospitals, communities, and populations.
(11) RHP plan--A multi-year plan within which
					 participants propose their portion of waiver funding and DSRIP
					 projects.
(12) Transition
					 payment--Payments available only during the first demonstration year.
(13) Uncompensated-care physician
					 application--A form prescribed by HHSC to identify uncompensated costs for
					 Medicaid-enrolled providers.
(14)
					 Uncompensated-care payments--Payments available after the first demonstration
					 year and calculated as described in subsection (g) of this section.
					 Uncompensated-care payments are intended to defray the uncompensated costs of
					 services that meet the definition of "medical assistance" contained in
					 §1905(a) of the Social Security Act that are provided by the physician
					 group practice to Medicaid eligible or uninsured individuals.
(15) Uninsured patient--An individual who has
					 no health insurance or other source of third-party coverage for services, as
					 defined by CMS.
(16) Waiver--The
					 Texas Healthcare Transformation and Quality Improvement Program Medicaid
					 demonstration waiver under §1115 of the Social Security Act.