The intent of the Texas Medicaid Waiver Application (UC Application) is to provide a simplified way to subsidize the costs incurred by hospitals and physicians for patient care services (as further defined below) provided to Medicaid and Uninsured patients that are not reimbursed through the claims adjudication process or by other supplemental payments. These unreimbursed Medicaid and Uninsured costs are determined based on one of two UC tools depending on the type of entity providing the service. These tools have been approved by the Centers for Medicare and Medicaid Services (CMS).
The Texas Hospital Uncompensated Care tool (TXHUC) will be utilized by hospitals to determine their unreimbursed costs for Medicaid and Uninsured patients for physician’s and mid-level professional’s direct patient care services where the hospital incurs these costs. In addition, if the hospital has unreimbursed hospital costs for services provided to Medicaid and Uninsured patients that were not paid via the claims adjudication process or thru the Medicaid Disproportionate Share (DSH) pool, these costs can be included in the TXHUC application. Also, for some hospitals meeting the criteria, unreimbursed pharmacy costs for take home drugs provided by the hospital to Medicaid and Uninsured patients will be included in the TXHUC application.
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