Standard Dollar Amount (SDA) Add-on Status Verification
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:
- FY 2015 Statewide SDA Status Verification File (HHSC derived)
- 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 11, 2014 in order for the revised add-on status to be considered for rates effective September 1, 2014.
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.
Each provider is required to verify their facility-specific hospital information is correct in the FY 2015 Statewide SDA Status Verification File. The FY 2015 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 2015 Statewide SDA Status Verification File, each hospital provider must then complete the FY 2015 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 2015 Statewide SDA Add-on Status Verification Form.
The FY 2015 Statewide SDA Add-on Status Verification Form is used to verify that the information contained 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 2015 Statewide SDA Add-on Status Verification File, please indicate on the FY 2015 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 FY2015 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 2015 Statewide SDA Add-on Status Verification Form by July 11, 2014.
|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|
If you have questions regarding the SDA add-on status verification process, please please call the appropriate person on the Contacts List.
Documentation provided to HHSC in a request to review information contained within the FY 2015 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 2015 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 2015 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 sections contained within the file which contain the hospitals list for urban, children's and rural hospitals. No action is required for those hospitals on the rural hospital list (i.e. rural hospitals do not receive add-on amounts to their SDA’s; this list is for informational purposes only).
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.
Sectiont 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 (9-1-2014).
- Column K - CBSA Wage Index - contains the reclassified wage index for each applicable hospital.
- Column L - Applicable Teaching Add-on (Medicare Operating IME%) - contains the Teaching SDA add-on percentage from the Medicare operating IME percentage for each hospital.
- Column M - Designation Status values are:
- I - Facility is in active pursuit of a trauma designation
- Y - Facility is currently trauma designated
- N - Facility is not currently trauma designated and is not in active pursuit of a trauma designation
- 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 - 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%).
Contact Rate Analysis
Updated: June 20, 2014