Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 355 - REIMBURSEMENT RATES › Subchapter J - PURCHASED HEALTH SERVICES › Division 4 - MEDICAID HOSPITAL SERVICES › Section 355.8058 - Inpatient Direct Graduate Medical Education (GME) Reimbursement

Current through Reg. 49, No. 28; July 12, 2024
(a) The Texas Health and Human Services
					 Commission (HHSC) uses the methodology in this subsection to calculate
					 Inpatient Direct Graduate Medical Education (GME) cost reimbursement for
					 state-owned or state-operated teaching hospitals.
(1) Effective September 1, 2008, HHSC or its
					 designee may reimburse a state-owned or state-operated teaching hospital with
					 an approved medical residency program the hospital's inpatient direct GME cost
					 for hospital cost reports beginning with state fiscal year 2009.
(2) Reimbursement of inpatient direct GME
					 cost for state-owned or state- operated teaching hospitals:
(A) Inpatient direct GME cost, as specified
					 under methods and procedures set out in the Social Security Act, Title XVIII,
					 as amended, effective October 1, 1982, by Public Law 97-248 is calculated under
					 similar methods for each hospital having inpatient direct GME costs on its
					 tentative or final audited cost report.
(B) Definitions.
(i) Base year average per resident
					 amount--the hospital's Medicaid allowable inpatient direct GME cost as reported
					 on CMS Form 2552-96, Hospital Cost Report ending in state fiscal year 2007;
					 Worksheet B; Part I; Column 26; Line 95, divided by the unweighted FTE
					 residents from Worksheet S-3; Part I; Line 25.
(ii) Current FTE residents--the hospital's
					 number of full time equivalent (FTE) interns, residents, or fellows who
					 participate in a program that is determined by HHSC to be a properly approved
					 medical residency program including a program in osteopathy, dentistry, or
					 podiatry, as required in order to become certified by the appropriate specialty
					 board, as reported on CMS Form 2552-96, Hospital Cost Report; Worksheet S-3;
					 Part I; Line 25.
(iii) GME Medicaid
					 inpatient utilization percentage--the hospital's proportion of paid Medicaid
					 inpatient days, including managed care days, as reported on CMS Form 2552-96,
					 Hospital Cost Report adjusted to Medicaid Claim Summary Report; Worksheet S-3;
					 Part 1; Line 12; Column 5, divided by the hospital's total inpatient days, as
					 reported on Worksheet S-3; Part 1; Column 6, Lines 12, 14 (subprovider days),
					 and 26 (observation days). Medicaid inpatient days and total inpatient days
					 will include inpatient nursery days.
(C) HHSC calculates the total GME payments
					 for each hospital as follows:
(i) multiplies
					 the base year average per resident amount by the applicable Centers for
					 Medicare and Medicaid Services (CMS) Prospective Payment System Hospital Market
					 Basket index;
(ii) multiplies the
					 results in clause (i) of this subparagraph by the number of current full-time
					 equivalent (FTE) residents; and
(iii) multiplies the results in clause (ii)
					 of this subparagraph by the GME Medicaid inpatient utilization percentage,
					 which results in the total GME payments.
(D) Inpatient direct GME costs are removed
					 from the reimbursement methodology and not used in the calculation of the
					 provider's inpatient cost settlement.
(E) The GME interim payments will be
					 reimbursed on a quarterly basis only after hospital services have been
					 rendered. The interim payments are payable within 90 days of the receipt of the
					 hospital's quarterly resident FTE data. Each hospital's quarterly resident FTE
					 data will be divided by 4 to determine the average resident FTEs for each
					 quarter. The interim payments will be reconciled and settled based on audited
					 final cost report data.
(F) To
					 receive GME payments from HHSC, a state-owned or state-operated teaching
					 hospital must be enrolled as a Medicaid provider with HHSC and provide
					 intergovernmental transfers to HHSC to fund the non-federal portion of
					 reimbursement for GME costs.