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Standard Dollar Amount (SDA) Add-on Status Verification

General Information

According to the Texas Administrative Code, §355.8052  related to Inpatient Hospital Reimbursement, hospitals may receive an annual SDA adjustment based upon their trauma designation.  If qualified, hospitals may also receive a medical education add-on at the beginning of the state fiscal year. 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, each hospital must review and verify that their facility-specific information is true and accurate as contained in the following two files:

  1. FY 2016 Statewide SDA Status Verification File (HHSC derived)
  2. Texas - FY 2012 Final Rule- IPPS Impact File PUF (reference use only)

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 13, 2015 in order for the revised add-on status to be considered for rates effective September 1, 2015.

If no errors are found in your hospital's data on the SDA Status Verification File, no response is required.  HHSC will calculate the facility specific add-ons for the hospital's final SDA using the information contained in the file.

No action is required for rural hospitals. Rural hospitals do not receive add-on amounts to their SDAs. The rural hospitals are listed for informational purposes only. Please do not submit verification forms for rural hospitals.

Instructions

Each provider is required to verify their facility-specific hospital information is correct in the FY 2016 Statewide SDA Status Verification File. The file contains a list of each hospital's facility specific information and proposed add-on designations.

After reviewing the FY 2016 Statewide SDA Status Verification File, each hospital provider must then complete the FY 2016 Statewide SDA Add-on Status Verification Form, including 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 FY 2016 Statewide SDA Add-on Status Verification Form allows providers to identify information contained within the files which are not correct. If an error or omission is found in the FY 2016 Statewide SDA Add-on Status Verification File, please indicate on the FY 2016 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 FY2016 Statewide SDA Add-on Status Verification Form. Further explanation of verifiable documentation is below.

Verification File

View FY 2016 Statewide SDA Status Verification File (pdf)

Additional Supporting Files

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

View Texas Trauma Facilities

Verification Form

View SDA Add-on Status Verification Form (.pdf)

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 2016 Statewide SDA Add-on Status Verification Form by July 13, 2015.

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

Verification Documentation

Documentation provided to HHSC in a request to review information contained within the FY 2016 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.

Contact Information

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

 

 

Contact Rate Analysis

Send email to Rate Analysis


Updated: June 26, 2015