Standard Dollar Amount (SDA) Add-on Status Verification
According to the Texas Administrative Code, §355.8052 related to Inpatient Hospital Reimbursement, hospitals may receive an annual SDA adjustment based upon their physical location, trauma designation, qualification as a safety-net hospital, and if qualified, hospitals may also receive a medical education add-on at the beginning of the state fiscal year. To comply with the rule, HHSC requires verification of the facility-specific information related to these SDA add-ons.
To ensure each provider receives their appropriate add-on payments, each hospital must review and verify that their facility-specific information is true and accurate as contained in the following two files:
- FY 2022 Statewide SDA Status Verification File (HHSC derived)
- Texas - FY 2012 Final Rule - IPPS Impact File PUF (reference use only)
If the add-on status in this file is not correct, the provider MUST submit the SDA Add-on Status Verification Form to inform HHSC of changes that should be made to correct the information contained in the verification files. The SDA Add-on Status Verification Form must be completed and returned to HHSC at the email or mailing address contained on the form by August 6, 2021 for the revised add-on status to be considered for rates effective September 1, 2021.
If no errors are found in your hospital's data on the SDA Status Verification File, no response is required. HHSC will calculate the facility specific add-ons for the hospital's final SDA using the information contained in the file.
For add-on purposes, no action is required for rural hospitals for the data in Columns K through Q. Rural hospitals do not receive the add-on amounts related to data in Columns K through Q to their SDAs. Rural hospitals are encouraged to review the listed information in Columns A through J. Please only submit verification forms for rural hospitals if facility specific information needs correction.
Each provider is required to verify their facility-specific hospital information is correct in the FY 2022 Statewide SDA Status Verification File. The file contains a list of each hospital's facility specific information and proposed add-on designations.
The FY 2022 Statewide SDA Add-on Status Verification Form allows providers to identify information contained within the files which are not correct. If an error or omission is found in the FY 2022 Statewide SDA Add-on Status Verification File, please indicate on the FY 2022 Statewide SDA Add-on Status Verification Form the location of the error and provide verifiable documentation of the correct information to HHSC by attaching the documentation to the FY 2022 Statewide SDA Add-on Status Verification Form. Further explanation of verifiable documentation is below.
Additional Supporting Files
Please send the Status Verification Form, the certification form, and any supporting documents to PFD_Hospitals@hhsc.state.tx.us or the mailing address below. Please remember HHSC must receive the completed FY 2022 Statewide SDA Add-on Status Verification Form by August 6, 2021.
|Regular Mail:||Overnight & Courier Delivery:|
|HHSC Provider Finance Department||HHSC Provider Finance Department|
|Mail Code H-400||Mail Code H-400|
|P.O. Box 149030||4601 Guadalupe St|
|Austin, Texas 78714||Austin, Texas 78751|
Documentation provided to HHSC in a request to review information contained within the FY 2022 Statewide SDA Status Verification File must be auditable and verifiable through reasonable sources. Examples of appropriate documentation include but are not limited to: public documents, filed court house documents, letters from the Medicare Geographic Classification Review Board, letters from the Texas Department of State Health Services, and letters from Centers for Medicare & Medicaid Services (CMS), or any other information which is verifiable and auditable.
If you have questions regarding the SDA add-on status verification process or specific questions regarding the completion of the SDA Add-on Status Verification Form, please contact PFD_Hospitals@hhsc.state.tx.us.