Hearing.  Health and Human Services Commission (HHSC) will conduct a public hearing to receive public comment on proposed Medicaid payment rates for hospital outpatient imaging services, hospital outpatient service reimbursement, and hospital inpatient reimbursement.  The hearing will be held in compliance with Texas Human Resources Code §32.0282 and Title 1 of the Texas Administrative Code (1 TAC) §355.201, which require public notice and hearings on proposed Medicaid reimbursements.    

Proposal.  HHSC proposes to increase payment rates for the following:

- Rural Hospital Outpatient Imaging Services
- Rural Hospital Outpatient General Services
- Hospital Inpatient Trauma Add-on

In addition, HHSC proposes a new safety-net add-on for Hospital Inpatient Services. 

The proposed rates will be effective September 1, 2015, and were determined in accordance with the rate setting methodologies described below under "Methodology and Justification."

Methodology and Justification. The proposed payment rates were determined accordance with the 2016-17 General Appropriations Act (84th Legislature, R.S., article II, at II-122 to II-123, II-133 to II-134 (Health and Human Services Section, Special Provisions, Sections 32, 58, and 59)) and are contingent upon the availability of funds. The proposed amendments will allow HHSC to implement increases in trauma add-ons and to implement a new standard dollar amount (SDA) add-on for certain safety-net hospitals. The amendments will also allow HHSC to increase reimbursement to rural hospitals for outpatient imaging services, general outpatient services, and non-emergent emergency room services.

The proposed payment rates were calculated in accordance with proposed amended rate setting methodologies at 1 TAC:

- §355.8061, which addresses payment for outpatient hospital services; and

- §355.8052, which addresses payment for inpatient hospital services

The proposed amendments were published in the June 26, 2015, issue of the Texas Register.

Proposed Outpatient Hospital Rates

- Imaging services in rural hospitals – Outpatient rural hospital imaging services will be reimbursed according to the outpatient hospital imaging service fee schedule with an add-on to the Medicaid fee schedule for non-rural hospitals that is stair-stepped. Fees will not exceed 100 percent of Medicare fees.

- Rural Hospitals – General outpatient covered charges are proposed to be increased to 100 percent for all rural hospitals. Reimbursement will not exceed 100 percent of cost.

- Non-emergent emergency department services in rural hospitals – Covered services provided in the hospital emergency department that do not qualify as an emergency are proposed to be increased from 60 percent to 65 percent of the covered charge amount. Reimbursement will not exceed 65 percent of cost.

Proposed Inpatient Hospital Rates
- Urban hospitals – Currently, an SDA trauma add-on is used for reimbursing urban hospitals that are designated as trauma facilities. To be eligible for the trauma add-on, a hospital must be designated as a trauma hospital by the Department of State Health Services. Proposed rates will increase the trauma add-on for eligible hospitals. The increase will be accomplished by increasing the percentage used to calculate the add-on.
- Urban and Children’s hospitals - A new SDA “safety-net” add-on is proposed for reimbursing hospitals using the existing statewide rate with an additional add-on payment. To be eligible for the add-on, a hospital must be an urban or children's hospital that provides inpatient services to a large percentage of Medicaid or uninsured patients.  The hospital must meet the eligibility and qualification requirements described in §355.8065.

Briefing Package.  A briefing package describing the proposed payment rates will be available at http://www.hhsc.state.tx.us/rad/rate-packets.shtml by July 10, 2015.  Those interested may obtain a copy of the briefing package before the hearing by contacting the Rate Analysis Department by telephone at 512-730-7401; by fax at 512-730-7475; or by email at kyle.baxter@hhsc.state.tx.us.  The briefing package also will be available at the public hearing. 

Written Comments.  Written comments regarding the proposed payment rates may be submitted instead of, or in addition to, oral testimony until 5 p.m. the day of the hearing. Written comments may be sent by U.S. mail, overnight mail, special delivery mail, hand delivery, fax, or email.

U.S. Mail
HHSC Rate Analysis Department, Mail Code H-400
P.O. Box 149030
Austin, Texas 78714-9030
Overnight mail, special delivery mail, or hand delivery
HHSC Rate Analysis Department, Mail Code H-400
Brown Heatly Building
4900 North Lamar
Austin, Texas 78751

Phone number for package delivery:  512-730-7401

Fax
Attention:  Kyle Baxter at 512-730-7475

Email
kyle.baxter@hhsc.state.tx.us