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 355.8210 - Waiver Payments to Governmental Ambulance Providers for Uncompensated Charity Care

Current through Reg. 49, No. 28; July 12, 2024
(a) Introduction.
					 Beginning October 1, 2019, Texas Healthcare Transformation and Quality
					 Improvement 1115 Waiver payments are available under this section for eligible
					 governmental ambulance providers to help defray the uncompensated cost of
					 charity care. Waiver payments to governmental ambulance providers for
					 uncompensated care provided before October 1, 2019, are described in §
											355.8600 of this subchapter
					 (relating to Reimbursement Methodology for Ambulance Services).
(b) Definitions.
(1) Centers for Medicare & 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.
(2)
					 Certified public expenditure (CPE)--An expenditure certified by a governmental
					 entity to represent its contribution of public funds in providing services that
					 are eligible for federal matching Medicaid funds.
(3) Charity care--Healthcare services
					 provided without expectation of reimbursement to uninsured patients who meet
					 the provider's charity-care policy. The charity-care policy should adhere to
					 the charity-care principles of the Healthcare Financial Management Association
					 Principles and Practices Board Statement 15 (December 2012). Charity care
					 includes full or partial discounts given to uninsured patients who meet the
					 provider's financial assistance policy. Charity care does not include bad debt,
					 courtesy allowances, or discounts given to patients who do not meet the
					 provider's charity-care policy or financial assistance policy.
(4) Demonstration year--The 12-month period
					 beginning October 1 for which the payments calculated under this section are
					 made. Demonstration year one was October 1, 2011, through September 30,
					 2012.
(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) 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.
(8) Governmental ambulance provider--An
					 ambulance provider that uses paid government employees to provide ambulance
					 services. The ambulance services must be directly funded by a governmental
					 entity. A private ambulance provider under contract with a governmental entity
					 to provide ambulance services is not considered a governmental ambulance
					 provider for the purposes of this section.
(9) Uncompensated-care application--A form
					 prescribed by HHSC to identify uncompensated costs for Medicaid-enrolled
					 providers.
(10) Uncompensated-care
					 payments--Payments intended to defray the uncompensated costs of charity care
					 as defined in paragraph (3) of this subsection.
(11) Uninsured patient--An individual who has
					 no health insurance or other source of third-party coverage for the services
					 provided. The term includes an individual enrolled in Medicaid who received
					 services that do not meet the definition of medical assistance in section
					 1905(a) of the Social Security Act (Medicaid services), if such inclusion is
					 specified in the hospital's charity-care policy or financial assistance policy
					 and the patient meets the hospital's policy criteria.
(12) Waiver--The Texas Healthcare
					 Transformation and Quality Improvement Program Medicaid demonstration waiver
					 under §1115 of the Social Security Act.