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Standard Dollar Amount (SDA) Add-on Status Verification

General Information

The Texas Health and Human Services Commission (HHSC) recently proposed an amendment to the rules related to the current Inpatient Hospital Reimbursement. To comply with the proposed amendment, HHSC is transitioning from the use of Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) reimbursement methodology for Children's Hospitals and Rural and Certain Other Hospitals to the 3MTM All Patient Refined Diagnosis Related Groups (APR-DRG) for hospital inpatient reimbursement. The rule amendment will also allow hospitals to receive an updated trauma add-on as well as an updated medical education add-on at the beginning of the state fiscal year for qualified hospitals. To comply with the rule, HHSC requires verification of the facility-specific information related to these SDA add-ons.

In order to ensure each provider receives their appropriate add-on payments, HHSC compiled a set of files which each provider must review and verify their facility-specific information is true and accurate. HHSC will calculate the facility specific add-ons for the hospital's final SDA using the information contained in the file unless notification is received by July 12, 2013 that any add-on status in this file is incorrect and should be revised. 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 address contained on the form by July 12, 2013 in order for the revised add-on status to be considered for rates effective September 1, 2013. If no errors are found in your hospital's data, no response is required. Please access the web link below to find the SDA Add-on Status Verification documents. Additional instructions will be available on the website for reviewing the data and providing documentation to correct any discrepancies or to the information in the file.

 

Instructions

Each provider is required to verify their facility specific hospital information is correct in the FY 2014 Statewide SDA Status Verification File. The FY 2014 Statewide SDA Status Verification File contains a list of each hospital's facility specific information and proposed add-on designations. Further explanation of the file is contained below in the File Descriptions section.

After reviewing the FY 2014 Statewide SDA Status Verification File, each hospital provider must then complete the FY 2014 Statewide SDA Add-on Status Verification Form along with the certification form if their add-on status needs correction. The verification form contains two verification options for the provider to select regarding their hospital specific information. The certification form is contained within the FY 2014 Statewide SDA Add-on Status Verification Form.

The FY 2014 Statewide SDA Add-on Status Verification Form is used to verify that the information contain in the files below is true, accurate and correct. The form also allows providers to identify information contained within the files which are not correct. If an error or omission is found in the FY 2014 Statewide SDA Add-on Status Verification File, please indicate on the FY 2014 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 FY2014 Statewide SDA Add-on Status Verification Form. Further explanation of verifiable documentation is below.

 

Verification File

View FY 2014 Statewide SDA Status Verification File (Excel)

 

Additional Supporting Files

View Texas - FY 2012 Final Rule- IPPS Impact File PUF (Excel)

 

Verification Form

View SDA Add-on Status Verification Form

Please send the Status Verification Form, the certification form, and any supporting documents to the mailing address below. Please remember HHSC must receive the completed FY 2014 Statewide SDA Add-on Status Verification Form by July 12, 2013.

Regular Mail: Overnight & 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 Information

If you have questions regarding the SDA add-on status verification process, please please call the appropriate person on the Contacts List.

 

Verification Documentation

Documentation provided to HHSC in a request to review information contained within the FY 2014 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.

 

Verification File Descriptions

FY 2014 Statewide SDA Status Verification File: Information contained within this file must be reviewed and verified to be true, accurate and correct by each provider. If an error is found it must be submitted through use of the FY 2014 SDA Add-on Status Verification Form and certification statement. The file contains a list of the hospitals, their hospital specific identifying information and add-on status information.

There are three tabs contained within the folder which contain the hospitals list for urban, children's and rural hospitals.

Below are descriptions of several key columns in the FY 2014 Statewide SDA Status Verification File. Please be sure to verify all columns contained in the FY 2014 Statewide SDA Status Verification File.

Worksheet 1: SDA Status Verification File

  • Column B - Texas Provider Identifier - contains each provider's TPI. Please be sure the TPI in Column B is correct as it relates to your facility currently or as of (9-1-2013).
  • Column J - CBSA Wage Index - contains the reclassified wage index for each applicable hospital.
  • Column K - Applicable Teaching Add-on (Medicare Operating IME%) - contains the Teaching SDA add-on percentage from the Medicare operating IME percentage for each hospital.
  • Column L - Applicable Trauma Add-on (Level I-IV) - contains the trauma designation for each provider from the Department of State Health Services.

 

Additional Supporting Files Descriptions

DSHS Trauma Hospital Listing: The Department of State Health Services list of the trauma hospitals and designation used for the SDA trauma add-on

Texas - FY 2012 Final Rule- IPPS Impact File PUF: The file contains the Texas in-state hospital specific information from the impact file from the Medicare Final Rule for the Inpatient Prospective Payment System (IPPS). The second tab contains a variable description for each row in tab one. This file was used as the Medicare source data to determine the CBSA, reclassification, and the Applicable Teaching Add-on (Medicare Operating IME%).

 

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Updated: September 26, 2013