In Texas, hospitals must apply and ultimately qualify for payment to participate in the Disproportionate Share Hospital (DSH) and Uncompensated Care Section 1115 waiver (UC) programs. Texas hospitals that wish to participate in either the FFY 2020 DSH and/or the demonstration year (DY) 9 UC must request an application to apply from HHSC and the online application request form must be submitted no later than 5 pm, Friday, September 20, 2019. Failure to apply by the deadline will result in the hospital not being able to participate in these Texas Medicaid Supplemental Payment Programs and loss of appeal rights to a non-qualification decision.
The online application request form can be found on the HHSC website or by clicking this link:
The information required includes:
Hospital Medicare number (CCN)
Hospital TPI number
- Ownership type
Primary hospital contact and information
DSH/UC application preparer contact and information
According to the HHSC website, an email confirmation should be sent within 1-3 business days verifying HHSC has received your request. Further, DSH/UC applications will be sent by HHSC to the contacts provided on or around the week of October 14, 2019. Providers will have 30 days to complete with the option to request a 15-day extension. For those contacts that will be preparing the DSH/UC application, data needed to complete the application will come from FFY 2018 for the FFY 2020/DY 9 program year.
Additionally, the following language is posted on the HHSC site that providers may want to review:
Providers may find eligibility, qualification, the conditions to participate, and payment allocation methodology in the DSH program in 1 Texas Administrative Code (TAC) Part 15, Sec.§355.8065., and the criteria for calculating the Hospital Specific Limit (HSL) used in the DSH program in Sec.§355.8066.
Providers may find eligibility and payment allocation methodology for the DY 9 UC program in 1 TAC Part 15, Sec. §355.8212 for hospitals and §355.8214 for physician groups. Beginning this year, UC will reimburse for uncompensated uninsured charity care costs instead of Medicaid and uninsured costs.
As you know, the Texas 1115 waiver extension was approved by CMS on December 21, 2017. For uncompensated care, the extension approval changed how funds will ultimately be paid, on an interim and final basis, for the five year extension period. As a condition of the Texas Medicaid 1115 Waiver renewal, the use of the current “UC tool” for Uncompensated Care payment distribution to Texas hospitals will be phased-out, and beginning in October 2019, the UC payments will be calculated and distributed based on charity care costs from Worksheet S-10 of the Medicare cost report.
For Texas UC payment application preparers, this change is a departure from year's past. Hospitals will need to verify that they have the necessary documentation needed from schedule S-10 of the CMS 2552 cost report in order to comply with the new reporting requirement. Even if you have not been required to file Worksheet S-10 per Medicare regulations in the past, you will now need to have S-10 information to complete the HHSC UC program application.
SCA will be composing follow up articles on the Texas waiver extension and Worksheet S-10 in the future. Don't miss related posts by subscribing to our blog.
SCA has completed 470 Worksheet S-10 engagements thus far and has been engaged to complete an additional 232, for a total of 702. SCA has also assisted clients through the new MAC S-10 audits, 63 and counting. Please contact SCA for more information on our S-10 reporting program, if you would like a copy of S-10 best practices, or if you have questions regarding the new Texas UC payment program.