1 TAC §355.8067
The Texas Health and Human Service Commission (HHSC) adopts
amended §355.8067, Medicaid Disproportionate Share Hospital (DSH) Reimbursement
Methodology. The amendment is adopted without changes to the proposed text
as published in the August 6, 2004, issue of the
Texas Register
(29 TexReg 7592) and will not be republished.
The state proposes to change §355.8067, Medicaid Disproportionate
Share Hospital (DSH) Reimbursement Methodology, by changing the Medicaid Disproportionate
Share Hospital (DSH) program to take advantage of the provisions in the Benefits
Improvement and Protection Act of 2000 (BIPA) that allow state hospitals to
receive DSH funding up to 175 percent of their uninsured costs and non-reimbursed
Medicaid costs for a two-year period, beginning September 1, 2003. Section
355.8067(e); has been amended to allow state teaching hospitals to receive
additional funding from the federal government.
HHSC received comments from the Texas Hospital Association regarding the
proposed changes to the rule during the comment period, which included a public
hearing on August 16, 2004. A summary of comments and HHSC's responses follows.
Comment: The Texas Hospital Association (THA) supports the Commission's
overall plan to increase Medicaid DSH payments made to the state hospitals
only if the aggregated hospital distribution of DSH funds to non-state hospitals
in 2004 and 2005 is equal to or greater than fiscal year 2003-levels and a
portion of the displaced funds are returned to Texas hospitals. The Texas
Hospital Association also stated that the Texas hospitals must have:
"Reinstatement of the adult medically needy spend-down program; and
Continuation of the 2.5 percent restoration in Medicaid hospitals payment
in state fiscal year 2005."
Response: HHSC acknowledges the comment received. These recommendations
are outside of the Commission's authority; therefore, no change was made to
the rules in response to these recommendations.
Comment: The Texas Hospital Association (THA) commented that its support
for the proposed DSH rules is dependent on "hold-harmless" DSH funding levels
to non-state hospitals.
Response: THA's comments are directed at the state's plan to increase Medicaid
DSH Reimbursement Methodology, by changing the Medicaid Disproportionate Share
Hospital DSH program in order to take advantage of the provisions in the Benefits
Improvement and Protection Act of 2000 (BIPA), which was agreed to by the
hospital industry. The association reminded the state that it would support
the state's proposed rule changes only if non-state hospitals were held harmless
by the changes. "Held harmless" means that a non-state hospital reimbursement
would not be reduced below the projected levels. The state has held the non-state
hospitals harmless in its application of the rules.
The amendment is adopted under the Texas Government Code §531.033,
which provides the commissioner of HHSC with broad rulemaking authority; the
Human Resources Code §32.021, and the Texas Government Code §531.021(a),
which provide HHSC with the authority to administer the federal medical assistance
(Medicaid) program in Texas; and the Texas Government Code §531.021(b),
which provides HHSC with the authority to propose and adopt rules governing
the determination of Medicaid reimbursements.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on January 14, 2005.
TRD-200500183
Steve Aragón
Chief Counsel
Texas Health and Human Services Commission
Effective date: February 3, 2005
Proposal publication date: August 6, 2004
For further information, please call: (512) 424-6900