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 355.8208 - Waiver Payments to Publicly-Owned Dental 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
					 publicly-owned dental providers to help defray the uncompensated cost of
					 charity care. Waiver payments to publicly-owned dental providers for
					 uncompensated care provided before October 1, 2019, are described in §
											RSA
					 355.8441 of this subchapter (relating to
					 Reimbursement Methodologies for Early and Periodic Screening, Diagnosis, and
					 Treatment (EPSDT) 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)
					 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.
(3)
					 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.
(4) 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.
(5) HHSC--The Texas Health and Human Services
					 Commission or its designee.
(6)
					 Intergovernmental transfer (IGT)--A transfer of public funds from a
					 governmental entity to HHSC.
(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)
					 Publicly-owned dental provider--A dental provider that uses paid government
					 employees to provide dental services directly funded by a governmental
					 entity.
(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 (2) 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.