Uncompensated Care Payments | Provider Finance Department

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.

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.