Standard Dollar Amount (SDA) Add-on Status Verification
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 Medicare Severity Diagnosis Related Groups (MS-DRG) to the 3MTM All Patient Refined Diagnosis Related Groups (APR-DRG) for hospital inpatient reimbursement.
The APR-DRGs, through expanded diagnosis and procedure codes, will enable HHSC to more precisely reimburse hospitals for the cost of providing Medicaid services. For state fiscal year 2013, the transition to the APR-DRG system will require the statewide standard dollar amount (SDA), existing add-ons to be rebased using fiscal year 2010 claims.
In order to ensure each provider receives their appropriate add-on status, HHSC compiled a set of files which each provider must verify their facility specific information contained in the files is true and accurate. Each provider MUST submit the SDA Add-on Status Verification Form to verify 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 June 11, 2012. Please follow the 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.
Each provider is required to verify their facility specific hospital information in the FY 2013 Statewide SDA Status Verification File. The FY 2013 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 2013 Statewide SDA Status Verification File, each hospital provider must then complete the FY 2013 Statewide SDA Add-on Status Verification Form and the certification form. The verification form contains three verification options for the provider to select regarding their hospital specific information. The certification form is contained within the FY 2013 Statewide SDA Add-on Status Verification Form.
The FY 2013 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 2013 Statewide SDA Add-on Status Verification File, please indicate on the FY 2013 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 FY2013 Statewide SDA Add-on Status Verification Form. Further explanation of verifiable documentation is below.
Additional Supporting Files
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 2013 Statewide SDA Add-on Status Verification Form by June 11, 2012.
|Regular Mail:||Overnight & Courier Delivery:|
|HHSC Rate Analysis||HHSC Rate Analysis|
|Mail Code H-400||Braker Center, Building H|
|P.O. Box 85200||Mail Code H-400|
|Austin, Texas 78708-5200||11209 Metric Blvd.|
|Austin, Texas 78758-4021|
If you have questions regarding the SDA add-on status verification process, please contact Laura Skaggs at firstname.lastname@example.org or (512)-491-1348 or Kevin Niemeyer at email@example.com or (512) 491-1366.
Documentation provided to HHSC in a request to review information contained within the FY 2013 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 2013 Statewide SDA Status Verification File: Information contained within this file must be reviewed and verified to be true, accurate and correct by each provider through the submission of a completed FY 2013 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.
Below are descriptions of several key columns in the FY 2013 Statewide
SDA Status Verification File. Please be sure to verify all columns contained
in the FY 2013 Statewide SDA Status Verification File.
Worksheet 1: SDA Status Verification File
- Column B - Texas Provider Identifier - contains each providers TPI. Please be sure the TPI in Column B is correct as it relates to your facility currently or as of (9-1-2012).
- Column K - Medicare Reclass Determination - contains an indication if a provider had been reclassified by Medicare by using the following: N -provider did not reclassify; W -provider reclassified for wage index ; L -provider reclassified under 1886(d)(8)(B) of the SSA; and N/A provider not available.
- Column L - Post RECLASS Labor Market Area - contains the labor market area used to determine the appropriate wage index. For hospitals which have been reclassified, the new labor market area is included in the listing.
- Column N - Applicable Teaching Add-on (Medicare Operating IME%) - contains the Teaching SDA add-on percentage from the Medicare operating IME percentage for each hospital.
- Column O - 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 Counties (CBSA) Standardized Wage Index: The Medicare impact file from the 2012 Medicare Final Rule for the Inpatient Prospective Payment System (IPPS) was used as a basis for this file. The Texas county wage index from the 2012 final rule was expanded using the hospital specific information contained in the impact file.
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 2012 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%).
Contact Rate Analysis
Updated: May 18, 2012