25 Tex. Admin. Code § 13.13 - Definitions
The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.
(1) Chapter
104--Provisions relating to the data collection responsibilities of the
Department of State Health Services as the state health planning and
development agency found within the Health and Safety Code, Title 2.
(2) Chapter 311--Provisions relating to the
powers and duties of hospitals found within the Health and Safety Code, Title
4.
(3) Charity care--The
unreimbursed cost to a hospital of providing, funding, or otherwise financially
supporting health care services on an inpatient or outpatient basis to a person
classified by the hospital as financially or medically indigent and/or
providing, funding or otherwise financially supporting health care services
provided to financially indigent persons through other nonprofit or public
outpatient clinics, hospitals or health care organizations.
(4) Community benefits--The unreimbursed cost
to a hospital of providing charity care, government-sponsored indigent health
care, donations, education, government-sponsored program services, research,
and subsidized health services. Community benefits do not include the cost to
the hospital of paying any taxes or other governmental assessments.
(5) Department--The Department of State
Health Services.
(6) Donations--The
unreimbursed costs of providing cash and in-kind services and gifts, including
facilities, equipment, personnel, and programs, to other nonprofit or public
outpatient clinics, hospitals, or health care organizations.
(7) Education-related cost--The unreimbursed
cost to a hospital of providing, funding, or otherwise financially supporting
educational benefits, services, and programs including education of medical
professionals and health care providers; scholarships and funding to medical
schools, colleges, and universities for health professions education; education
of patients concerning diseases and home care in response to community needs;
and community health education through informational programs, publications,
and outreach activities in response to community needs.
(8) Financially indigent--An uninsured or
underinsured person who is accepted for care with no obligation or a discounted
obligation to pay for the services rendered based on the hospital's eligibility
system.
(9) Government sponsored
indigent health care--The unreimbursed cost to a hospital of providing health
care services to recipients of Medicaid and other federal, state, or local
indigent health care programs, eligibility for which is based on financial
need.
(10) Government-sponsored
program unreimbursed costs--The unreimbursed cost to the hospital of providing
health care services to the beneficiaries of Medicare, the Civilian Health and
Medical Program of the Uniformed Services, and other federal, state, or local
government health care programs.
(11) Health care facility--Regardless of
ownership, a public or private hospital, skilled nursing facility, intermediate
care facility, ambulatory surgical facility, family planning clinic which
performs ambulatory surgical procedures, rural health initiative clinic, urban
health initiative clinic, kidney disease treatment facility, inpatient
rehabilitation facility, and other facilities as defined by federal law, but
does not include the office of physicians or practitioners of the healing arts
singly or in groups in the conduct of their profession.
(12) Health care organization--A nonprofit or
public organization that provides, funds, or otherwise financially supports
health care services provided to financially indigent persons.
(13) Hospital--A general or special hospital
licensed under the Health and Safety Code, Chapter 241; a private mental
hospital licensed under the Health and Safety Code, Chapter 577; and a
treatment facility licensed under the Health and Safety Code, Chapter
464.
(14) Hospital eligibility
system--The financial criteria and procedure used by a hospital to determine if
a patient is eligible for charity care. The system shall include income levels
and means testing indexed to the federal poverty guidelines; provided, however,
that a hospital may not establish an eligibility system which sets the income
level eligible for charity care lower than that required by counties under
§61.023 or higher, in the case of the financially indigent, than 200% of
the federal poverty guidelines. A hospital may determine that a person is
financially or medically indigent pursuant to the hospital's eligibility system
after health care services are provided.
(15) Hospital system--A system of local
nonprofit hospitals under the common governance of a single corporate parent
that are located within a radius of not more than 125 linear miles of the
corporate parent.
(16) Medically
indigent--A person whose medical or hospital bills after payment by third-party
payors exceed a specified percentage of the patient's annual gross income,
determined in accordance with the hospital's eligibility system, and the person
is financially unable to pay the remaining bill.
(17) Net patient revenue--An accounting term
that shall be calculated in accordance with generally accepted accounting
principles for hospitals.
(18)
Nonprofit hospital--
(A) A hospital that is
organized as a nonprofit corporation or a charitable trust under the laws of
this state or any other state or country and is:
(i) eligible for tax-exempt bond financing;
or
(ii) exempt from state
franchise, sales, ad valorem, or other state or local taxes. For purposes of
determining whether a hospital is "organized" as a nonprofit corporation or
charitable trust, the department will look at the entity which holds the
hospital license issued by the department; that is the entity which must be
organized as a nonprofit corporation or charitable trust.
(B) A "nonprofit hospital" shall not include
a hospital that:
(i) is exempt from state
franchise, sales, ad valorem, or other state or local taxes;
(ii) does not receive payment for providing
health care services to any inpatients or outpatients from any source
including, but not limited to, the patient or any person legally obligated to
support the patient, third-party payers, Medicare, Medicaid, or any other
federal, state, or local indigent care program; payment for providing health
care services does not include charitable donations, legacies, bequests, or
grants or payments for research; and
(iii) does not discriminate on the basis of
inability to pay, race, color, creed, religion, or gender in its provision of
services.
(C) A
"nonprofit hospital" does not include a hospital that is located in a county
with a population under 50,000 where the entire county or the population of the
entire county has been designated as a health professional shortage area. A
"nonprofit hospital" includes a hospital that is located in a county with a
population under 50,000 population where only a subpopulation, partial
geographic area or a facility is designated as a health professional shortage
area.
(19) Patient
data--Information derived from individual, acute care, inpatient, and
outpatient discharge abstract records.
(20) Subsidized health services--Services
provided by a hospital in response to community needs for which the
reimbursement is less than the hospital's cost for providing the services and
which must be subsidized by other hospital or nonprofit supporting entity
revenue sources. Subsidized health services include, but are not limited to,
emergency and trauma care, neonatal intensive care, freestanding community
clinics, and collaborative efforts with local government or private agencies in
preventive medicine.
(21)
Survey--The annual data collection effort conducted by the department to
implement the provisions of Health and Safety Code, Chapters 104 and
311.
(22) Tax exempt benefits--All
of the following, calculated in accordance with standard accounting principles
for hospitals for tax purposes using the applicable statutes, rules and
regulations regarding the calculation of these taxes:
(A) the dollar amount of federal, state, and
local taxes foregone by a nonprofit hospital and its nonprofit supporting
entities. For purposes of this definition federal, state, and local taxes
include income, franchise, ad valorem, and sales taxes;
(B) the dollar amount of contributions
received by a nonprofit hospital and its nonprofit supporting entities;
and
(C) the value of tax-exempt
bond financing received by a nonprofit hospital and its nonprofit supporting
entities.
(23)
Unreimbursed costs--The costs a hospital incurs for providing services after
subtracting payments received from any source for such services including but
not limited to the following: third-party insurance payments; Medicare
payments; Medicaid payments; Medicare education reimbursements; state
reimbursements for education; payments from drug companies to pursue research;
grant funds for research; and disproportionate share payments. For purposes of
this definition, the term "costs" shall be calculated by applying the cost to
charge ratios derived in accordance with generally accepted accounting
principles for hospitals to billed charges. The calculation of the cost to
charge ratios shall be based on the most recently completed and audited prior
fiscal year of the hospital or hospital system. For purposes of this
definition, charitable contributions and grants to a hospital, including
transfers from endowment or other funds controlled by the hospital or its
nonprofit supporting entities, shall not be subtracted from the costs of
providing services for purposes of determining the unreimbursed costs of
charity care and government-sponsored indigent health care.
Notes
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