Tex.
Gov't Code Section 543A.0152
Reimbursement Adjustments
(a)
The commission shall use the data collected under Section 543A.0151 (Collecting Certain Information; Reports to Certain Hospitals) and the diagnosis-related groups (DRG) methodology implemented under Section 543A.0005 (Payment Methodology Conversion), if applicable, to adjust, to the extent feasible, child health plan program and Medicaid reimbursements to hospitals, including payments made under the disproportionate share hospitals and upper payment limit supplemental payment programs. The commission shall base an adjustment for a hospital on the hospital’s performance with respect to exceeding or failing to achieve outcome and process measures developed under Section 543A.0002 (Development of Outcome and Process Measures; Correlation with Increased Reimbursement Rates) that address the rates of potentially preventable readmissions and potentially preventable complications.(b)
The commission must provide the report required by Section 543A.0151 (Collecting Certain Information; Reports to Certain Hospitals)(c) to a hospital at least one year before adjusting child health plan program and Medicaid reimbursements to the hospital under this section.
Source:
Section 543A.0152 — Reimbursement Adjustments, https://statutes.capitol.texas.gov/Docs/GV/htm/GV.543A.htm#543A.0152 (accessed Jun. 5, 2024).
