Current through Reg. 49, No. 38; September 20, 2024
(a) Annual report of the Community Benefits
Plan (CBP).
(1) The annual CBP report may be
filed with the department on a hospital or hospital system basis. A CBP
developed by a hospital serves as a hospital's operational plan for serving the
community's health care needs and sets out goals and objectives for providing
community benefits that include charity care and government-sponsored indigent
health care.
(2) A nonprofit
hospital or hospital system shall file an annual CBP report with the department
no later than April 30 of the following year.
(3) The nonprofit hospital's or hospital
system's annual CBP report must include, at a minimum:
(A) the hospital's or hospital system's
mission statement;
(B) a disclosure
of the health care needs of the community that were considered in developing
the CBP;
(C) a disclosure of the
amount and types of community benefits, including charity care, actually
provided. Charity care shall be reported as a separate item from other
community benefits;
(D) a statement
of its total operating expenses computed in accordance with generally accepted
accounting principles for hospitals from the most recent completed and audited
prior fiscal year of the hospital; and
(E) a completed worksheet that computes the
ratio of cost to charge for the fiscal year referred to in subparagraph (D) of
this paragraph and that includes the same requirements as Worksheet 1-A adopted
by the department in August 1994 for the 1994 "Annual Statement of Community
Benefits Standard".
(4)
In addition to the annual CBP report, a nonprofit hospital or hospital system
shall file a completed worksheet as required by paragraph (3)(E) of this
subsection no later than ten working days after the date the hospital or
hospital system files its Medicare cost report.
(b) Annual statement of community benefits
standard (ASCBS).
(1) Each nonprofit hospital
or hospital system shall also report the following information to the
department as the ASCBS part of the online survey form:
(A) the amount of charity care
provided;
(B) the amount of
government-sponsored indigent health care provided;
(C) the amount of community benefits
provided;
(D) the amount of net
patient revenue and the amount constituting 4.0% of net patient
revenue;
(E) the dollar amount of
the hospital's or hospital system's charity care and community benefits
requirements met;
(F) the amount of
tax-exempt benefits provided, if the hospital is required to report tax-exempt
benefits under subsection (b)(3)(A) or (B) of this section;
(G) the amount of charity care expenses
reported in the hospital's or hospital system's audited financial statement;
and
(H) a brief summary of the
charity care policy and community benefits provided by each hospital unless the
hospital is a public hospital or for-profit hospital participating in the
Medicaid disproportionate share program.
(2) The ASCBS shall be filed online with the
department on a hospital or hospital system basis.
(3) A nonprofit hospital or hospital system
is required to file an annual statement with the department no later than 120
days after the hospital's or hospital system's fiscal year ends; however, the
department will accept the ASCBS as partially fulfilling the requirement to
submit an annual report of the hospital or hospital system CBP. The ASCBS filed
under this subsection shall be based on the most recently completed and audited
prior fiscal year of the hospital and shall state which of the standards for
providing community benefits has been satisfied. A nonprofit hospital or
hospital system may elect to provide community benefits according to any of the
following standards:
(A) charity care and
government-sponsored indigent health care are provided at a level which is
reasonable in relation to the community needs, as determined through the
community needs assessment, the available resources of the hospital or hospital
system, and the tax-exempt benefits received by the hospital or hospital
system, and other factors that may be unique to the hospital or hospital
system, such as the hospital's or hospital system's volume of Medicare and
Medicaid patients;
(B) charity care
and government-sponsored indigent health care are provided in an amount equal
to at least 100% of the hospital's or hospital system's tax-exempt benefits,
excluding federal income tax; or
(C) charity care and community benefits are
provided in a combined amount equal to at least 5.0% of the hospital's or
hospital system's net patient revenue, provided that charity care and
government sponsored indigent health care are provided in an amount equal to at
least 4.0% of net patient revenue.
(4) For purposes of satisfying paragraph
(3)(C) of this subsection, a hospital or hospital system may not change its
existing fiscal year unless the hospital or hospital system changes its
ownership or corporate structure as a result of a sale or merger.
(5) A nonprofit hospital or hospital system
shall use the ASCBS part of the online survey form and accompanying worksheets
developed by the department for reporting under this section. Hospitals
electing to report on a system basis shall consolidate the individual hospital
information into a single ASCBS form for the online system. A separate set of
worksheets shall be completed for each individual hospital included in the
system.
(6) The department will
accept written revisions of the ASCBS for 30 days after the filing
date.
(7) The department may
request missing or incomplete data by written or telephone request. Nonprofit
hospitals or hospital systems shall answer all requests received from the
department in the time frame specified by the department.
(8) A nonprofit hospital that has been
designated as a disproportionate share hospital under the state Medicaid
program in the current fiscal year or in either of the previous two fiscal
years shall be deemed in compliance with these standards.
(9) A hospital that satisfies paragraph
(3)(A) or (8) of this subsection shall be excluded in determining a hospital
system's compliance with the standards provided in paragraphs (3)(B) and (C) of
this subsection.
(10) A nonprofit
hospital or hospital system under contract with a local county to provide
indigent health care services under Health and Safety Code, Chapter 61 may
credit unreimbursed costs from direct care provided to an eligible county
resident toward meeting the nonprofit hospital's or hospital system's charity
care and government-sponsored indigent health care requirement.
(c) Reporting.
(1) The department shall notify nonprofit
hospitals in writing that the annual report of the community benefits plan and
the online ASCBS form that includes a brief summary of charity care policy and
community benefits must be filed in accordance with these rules.
(2) Nonprofit hospitals changing to a
hospital system reporting basis shall report for a continuous period of
time.
(3) All hospitals or hospital
systems shall report as required under this title if the hospital or hospital
system, for the previous fiscal year, reported as a nonprofit hospital or
hospital system under §
13.15
of this title (relating to Survey Forms and Methods of Reporting
Data).
(4) All hospitals or
hospital systems shall report any change of ownership which may affect the
nonprofit status of the hospital or hospital system to the Center for Health
Statistics, Hospital Survey Unit, at the department within 60 days of the
effective date of the change.
(d) Posting of sign. Nonprofit hospitals
shall prepare a statement notifying the public that the annual report of the
CBP is public information, that it is filed with the department, and that it is
available on request from the Center for Health Statistics, Hospital Survey
Unit, Department of State Health Services, 1100 West 49th Street, Austin, Texas
78756. The statement must indicate the report's availability date and be posted
in prominent places throughout the hospital, including, but not limited to, the
waiting areas of the emergency room and the admissions office. Nonprofit
hospitals shall also print the statement in the patient guide or other
materials that provide the patient with information about the hospital's
admissions criteria.
(e) Charity
care notice. Each hospital shall provide, to each person who seeks any health
care service at the hospital, notice, in appropriate languages, if possible,
about the charity care program, including the charity care and eligibility
policies of the program, and how to apply for charity care. Such notice shall
also be conspicuously posted in the general waiting area, in the waiting area
for emergency services, in the business office, and in such other locations as
the hospital deems likely to give notice of the charity care program and
policies. Each hospital shall annually publish notice of the hospital's charity
care program and policies in a local newspaper of general circulation in the
county. Each notice under this subsection must be written in language readily
understandable to the average reader.
(f) Exemptions. A nonprofit hospital is
exempt from the reporting requirement in subsection (c) of this section if the
hospital is located in a county with a population under 50,000 and in which the
entire county or the population of the entire county has been designated as a
"Federally designated Health Professional Shortage Area (HPSA)" during the
current or any previous fiscal year and has continued to maintain that
designation.
(g) For purposes of
this section only (excluding subsection (b)(1)(H) of this section), a nonprofit
hospital shall include a nonprofit hospital as defined in §
13.13 of
this title and:
(1) a Medicaid
disproportionate share hospital; or
(2) a public hospital that is owned or
operated by a political subdivision of municipal corporation of the state,
including a hospital district or authority.
