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 355.8060 - Reimbursement Methodology for Freestanding Psychiatric Facilities

Current through Reg. 49, No. 28; July 12, 2024
(a) Introduction. HHSC uses the methodology
					 described in this section to calculate a per diem reimbursement for covered
					 inpatient hospital services in freestanding psychiatric facilities.
(b) Reimbursement to freestanding psychiatric
					 facilities. HHSC reimburses freestanding psychiatric facilities using a
					 prospective facility-specific per diem rate. The per diem rate will be
					 determined based on the Medicare base per diem for inpatient psychiatric
					 facilities with facility-based adjustments for wages, rural location, and
					 length of stay as determined by Medicare, to the extent possible within
					 available funds. HHSC or its designee will not cost settle for services
					 provided to recipients admitted as inpatients to freestanding psychiatric
					 facilities reimbursed under the prospective payment system. The freestanding
					 psychiatric facility inpatient per diem rates are for Medicaid clients under 21
					 years of age. Per diem rates will be increased only if the Texas Legislature
					 appropriates funds for this specific purpose.
(c) Reimbursement to children's freestanding
					 psychiatric facilities. An in-state freestanding psychiatric facility that
					 serves primarily individuals under the age of 21 will be exempt from the
					 freestanding psychiatric facility prospective payment system methodology
					 described in subsection (b) of this section and instead be reimbursed under
					 methods and procedures described in the Tax Equity and Fiscal Responsibility
					 Act of 1982 (TEFRA) described in subsection (d) of this section, if the
					 facility meets the following requirements:
(1) After a Medicaid participating
					 freestanding psychiatric facility is recognized by Medicare as a freestanding
					 psychiatric facility, it must request of HHSC or its designee that the facility
					 be reimbursed as a children's psychiatric hospital. The hospital must submit
					 its request on or after September 1, 2008, in writing, to HHSC or its
					 designee's provider enrollment contact and include documentation showing that
					 during the previous two hospital fiscal years, at least 95 percent of the
					 hospital's total inpatient days were for services to individuals under the age
					 of 21. HHSC will cost settle the annual cost report for the hospital fiscal
					 year in which the request was submitted.
(2) After a freestanding psychiatric facility
					 has been recognized by HHSC as a children's psychiatric hospital, it must
					 annually submit documentation with its annual cost report to HHSC or its
					 designee responsible for receiving submitted cost reports for continued
					 recognition as a children's psychiatric hospital. The documentation must show
					 that at least 95 percent of its total inpatient days were for services to
					 individuals under the age of 21. A hospital that does not meet this 95 percent
					 threshold based on its annual cost report will be reimbursed based on the
					 prospective facility-specific per diem rate described in subsection (b) of this
					 section, effective the first day of the hospital fiscal year following the cost
					 reporting period in which the hospital did not meet the 95 percent
					 threshold.