Overview
Historically every private hospital that participates in the waiver must execute an affiliation agreement with the governmental entity that provides the Intergovernmental Transfer (IGT) for any type of payment (transition, Uncompensated Care (UC) or Delivery System Reform Incentive Payment (DSRIP)). Hospitals receiving transition payments already have the necessary affiliation agreements on file. Read more about overview (.pdf). Beginning in the Demonstration Year (DY) 12, this is no longer a requirement.
Methodology/Rules
The Waiver Payments to Hospitals and Waiver Payments for Physician Services rules are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 11.
The 1115 Waiver rules are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter D.
Condition of Participation
In accordance with Texas Administrative Code §355.8212, beginning FFY 2024, all hospitals, except for state-owned and rural hospitals, are required to enroll, participate in, and comply with requirements for voluntary supplemental Medicaid or directed Medicaid programs for which the hospital is eligible within the State of Texas to participate in UC. Details on this requirement can be found in §355.8212 (c)(1)(F). A list of the required programs to satisfy this condition of participation is available for viewing here (.pdf).
Allocation Form
1115 Transformation Waiver IGT Allocation Confirmation Sheet: The waiver payment team has developed a new allocation confirmation spreadsheet for governmental entities to complete as a step in the payment process. Read more about allocation form (.pdf)
UC Withheld Payments
The DY3-DY6 UC withheld payment amounts can be found here (.pdf). Please note that these amounts are subject to change when ineligible providers are removed and when HHSC caps providers at the final UCC calculated in the UC reconciliation for the applicable program year.
UC IGT Commitments
DY 13
View DY 13 UC IGT Commitments File for Hospitals and Physician Groups (.xlsx) (Updated 07/25/2024)
IGT Commitment form is available here (.pdf) and the excel version can be located here (.xlsx)
DY12
View DY12 UC IGT Commitments File for Hospitals and Physician Groups (.xlsx) (Updated 08/01/2023)
DY11
View DY11 UC IGT Commitments File for Hospitals and Physician Groups (.xlsx) (Updated 08/30/2022)
UC Final Calculation Files
DY13
View DY13 UC Final Calculation File for Hospitals and Physician Groups (.xlsx) (Updated 08/22/2024)
DY12
View DY12 UC Final Calculation File for Hospitals and Physician Groups (.xlsx) (Updated 08/16/2023)
DY11
View DY11 UC Final Calculation File for Hospitals and Physician Groups (.xlsx)
View DY11 UC TXPUC withheld and additional hospital payment (.xlsx)
UC Advance Calculation Files
View DY13 UC Advance Calculation File for Hospitals and Physician Groups (.xlsx) (Updated 01/17/2024)
View DY12 UC Advance Calculation File for Hospitals and Physician Groups (.xlsx)
- Payment Information
View the 2023 DY12 Uncompensated Care Expenditures (.pdf)
View the 2022 DY11 Uncompensated Care Expenditures (.pdf)
View the 2021 DY10 Uncompensated Care Expenditures (.pdf)
View the 2020 DY9 Uncompensated Care Expenditures (.pdf) (Updated 09/15/2020)
View the 2019 DY8 Uncompensated Care Expenditures (.pdf)
View the 2018 DY7 Uncompensated Care Expenditures (.pdf)
View the 2017 DY6 Uncompensated Care Expenditures (.pdf)
View the 2016 DY5 Uncompensated Care Expenditures (.pdf)
View the 2015 DY4 Uncompensated Care Expenditures (.pdf)
View the 2014 DY3 Uncompensated Care Expenditures (.pdf)
Additional Information
Providers that have a payment recoupment will be notified separately by HHSC regarding the process for recouping amounts owed.
UC SDA Allocation Form (.xlsx)
UC Payment Protocol Attachment H (.pdf) (Updated 04/23/2020)
View the Final 2012 UC IGTs (.pdf)
Waiver Payment Forms for UC/DSRIP Providers
Guidelines for Participating in Transformation Waiver Payments (.pdf)
UC Application Fee Voucher (.pdf)