Rate Analysis for Hospital Services
NOTE: The HHSC Rate Analysis Department has moved locations. See our new mailing address below.
The 2013 UC Applications are available upon request. Requests must be submitted by December 13, 2013. Click here for detailed information Uncompensated Care Reporting Tools
2013 Outpatient Reimbursement Notice
TMHP will implement outpatient reimbursement changes required by Rider 51 of the 2014-2015 General Appropriations Act (Article II, Health and Human Services Commission S.B. 1, 83rd Legislature, Regular Session) in December 2013. The changes will be effective for claims with a beginning date of service on or after September 1, 2013. TMHP will reprocess all previously paid hospital outpatient claims with a beginning date of service on or after September 1, 2013 after implementation of the modifications to the claims processing system.
Upon implementation of the changes to the Texas Medicaid Management Information System (MMIS), TMHP will reprocess all previously paid hospital outpatient claims with a beginning date of service of September 1, 2013. This reprocessing will likely result in recoupments of a portion of the funds paid for these services since the changes required by Rider 51 included reductions in certain outpatient reimbursements. The reimbursement rules can be viewed at TAC Rule §355.8061.
Imaging fee updates were implemented and effective September 1, 2013.
The Health and Human Services Commission (HHSC) Rate Analysis for Hospital Services develops reimbursement methodology rules for determining payment rates/fees for Medicaid Hospital Services. General Medicaid program rules for Hospital Services are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter A, Division 10, Rule §354.1121. Additional general Medicaid program rules for Hospital Services are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter A, Division 11, Rules 1131-1190. HHSC Rate Analysis for Hospital Services develops payment rates/fees in accordance with published rules and policy guidelines for Hospital Services.
Clinic and Facility Services
- Ambulatory Surgical Center/Hospital Ambulatory Surgical Center (ASC/HASC)
- Federally Qualified Health Centers (FQHCs)
- Institutions for Mental Disease (IMD)
- Renal Dialysis Facility
- Rural Health Clinics (RHCs)
- Inpatient Services
- Outpatient Services
- Hospital Supplemental Payment Services
- Disproportionate Share Hospitals (DSH)
- Graduate Medical Education (GME)
- Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver
- Disproportionate Share Hospital (DSH) and Upper Payment Limit (UPL) Program Expenditures Survey
- Standard Dollar Amount (SDA) Add-on Status Verification
|Regular Mail:||Overnight and Courier Delivery:|
|HHSC Rate Analysis||HHSC Rate Analysis|
|Mail Code H-400||Mail Code H-400|
|P.O. Box 149030||4900 North Lamar|
|Austin, Texas 78714||Austin, Texas 78751|
Contact Rate Analysis
Updated: November 27, 2013