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. All UC payments to providers and all expenditures described as UC permissible expenditures must not exceed the cost of services provided to Medicaid and Uninsured patients as defined and discussed in this protocol. These unreimbursed Medicaid and Uninsured costs are determined based on one of two UC applications depending on the type of entity providing the service. These applications have been approved by the Centers for Medicare and Medicaid Services (CMS). To the extent that there are UC expenditures a hospital provider wants to make against the UC cost limit, and the methodology for capturing such expenditures is not stated in this protocol, the expenditures must be approved by CMS prior to the submission of the reconciliation for the applicable period for the expenditures. Read more…
The Hospital Services program rules are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter A, Division 6.
Reimbursement rules applicable to Hospitals are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 4.
The Waiver Payment program rules are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 355, SubChapter J, Division 11.
DSH/UC Application Information
For additional guidance on completing the UC application, please review the documents below:
View the DSH/UC Application (.xlsx)
Access the TXHUC Checklist for completion of UC Tool (.xls)
Access the TXPUC Checklist for completion of UC Tool (.xls)
View the TX Physician Time Study Form (.xls)
View the TX Physician Time Study Summary (.xls)
View the Mid-Level Professional Time Study Form (.xls)
View the Mid-Level Professional Time Study Summary (.xls)
View the Required Affiliation Agreements and Certification Forms
Note: Rate Analysis staff can assist you with questions concerning only payment rates for the specified services. They are not able to answer other types of questions, such as the status of payment for services rendered or questions involving eligibility for care services.
If you have questions regarding Hospitals - Inpatient and Outpatient Hospital Services payment rates, please call the appropriate person on the Contacts List.
If you have questions regarding Hospitals program/policy issues, please call the TMHP Contact Center at 1-800-925-9126.
Updated: February 1, 2017