Proposed Rule for the Medicaid Reimbursement for Hospital Outpatient Services

The Health and Human Services Commission (HHSC) conducted a public hearing to receive comments regarding the proposed adjustments to Medicaid rates detailed in this document on August 26th, 2021, at 9:00 a.m. HHSC will consider all concerns expressed at the hearing prior to final rate approval. HHSC is required by Senate Bill 1 (S.B. 1), Article II, Rider 8(f), 87th Legislature, Regular Session 2021 to allocate certain funds appropriated to provide an increase to outpatient reimbursement rates for rural hospitals. HHSC proposes an increase to outpatient services reimbursement by removing the cap that was established September 1, 2013 and applying a percentage increase to the cost to charge ratios for rural hospitals. This proposal will also eliminate the cost settlement of payments to maintain the level of payment directed by the rider. Rider 8 states that reimbursement for outpatient emergency department services which do not qualify as emergency visits may not exceed 65 percent of