Amend CSSB 1, Article III, as follows: On page III-216 and III-217 of the bill pattern for the Special Provisions Relating Only to State Agencies of Higher Education" amend the following text: Sec. 22.Unsponsored CharityUncompensated Care Reporting Requirement. The public health-related institutionslisted in Sec. 22, 1.Financially Indigent, shall use the appropriations in this Act to include in their biennial legislative appropriations request information including the actual amount of uncompensatedcharitycare provided through each institution's respective physician practice plan, and if applicable, hospital or clinic using thedefinition of unsponsored charity care set forth in the following sub-sections.uncompensated care reporting requirements established by the Health & Human Services Commission. Uncompensated care includes the unreimbursed costs for the uninsured (those with no source of third party insurance) and the underinsured (those with insurance who after contractual adjustments and third party payments have a responsibility to pay for an amount they are unable to pay). Uncompensated care also includes the unreimbursed costs from government sponsored health programs. To calculate uncompensated care, charges will be converted to costs by application of a standard, auditable ratio of cost to charge and providers will recognize appropriate patient specific funding and lump sum funding available to offset costs.1. Financially Indigent. Unsponsored charity care shall include unreimbursed services to the financially indigent. Financially indigent shall mean uninsured or underinsured patients accepted for care with no obligation or a discounted obligation to pay for services rendered based on a teaching hospital's or clinic's formal eligibility system which may include: (a) income levels and means testing or other criteria for determining a patient's inability to pay; or (b) other criteria for determining a patient's inability to pay that are consistent with the hospital's or clinic's mission and established policy. The federal poverty level shall serve as an index for the threshold below which patients receiving care at The University of Texas Southwestern Medical Center at Dallas, The University of Texas Medical Branch at Galveston, The University of Texas Health Science Center at Houston, The University of Texas Health Science Center at San Antonio, The University of Texas M.D. Anderson Cancer Center, The University of Texas Health Science Center at Tyler, Texas A&M University System Health Science Center, The Texas Tech University Health Sciences Center, and The University of North Texas Health Science Center are deemed financially indigent. Financially indigent services include both noncovered services and contractual allowances for patients eligible for the Medicaid program and for the Children with Special Health Care Needs program, services provided under county indigent care contracts (Sec. 23), and services provided under other state or local government programs with eligibility indexed to the federal poverty level.2. Medically Indigent. Unsponsored charity care shall include unreimbursed services to the medically indigent. Medically indigent shall mean patients who are responsible for their living expenses, but whose medical and hospital bills, after payment by third party payers, where applicable, exceed: (a) a specified percentage of the patient's annual gross income (i.e., catastrophic medical expenses) in accordance with a teaching hospital or clinic's formal eligibility system in such instances where payment would require liquidation of assets critical to living or earning a living; or (b) the criteria for determining a patient's inability to pay as established by the public health related institutions listed in Sec. 22, 1. Financially Indigent.3. Charity Care Determination. The determination that a patient is financially or medically indigent shall occur within 120 days of the patient's discharge from the hospital or clinic setting or within 120 days of the third party payor settlement.4. Contractual Adjustments. The contractual adjustments to commercial contracts, managed care contracts, and Medicare for the public health related institutions listed in Sec. 22, 1. Financially Indigent, shall not be counted as unsponsored charity care.5. Bad Debt. Bad debts shall not be counted as unsponsored charity costs. Bad debts shall include the uncollected billed charges for services rendered to patients who do not quality under the definition of unsponsored charity care.6. Patient Income Eligibility Guidelines. The University of Texas Medical Branch at Galveston, The University of Texas M.D. Anderson Cancer Center, and The University of Texas Health Science Center at Tyler shall use the federal poverty level indexed at an agreed upon level as the guideline for determining indigent patients status, and those institutions' eligibility guidelines regarding copayment by patients deemed financially or medically indigent shall be the same.The University of Texas Southwestern Medical Center at Dallas, The University of Texas Health Science Center at Houston, The University of Texas Health Science Center at San Antonio, Texas A&M University System Health Science Center, the Texas Tech University Health Sciences Center, and The University of North Texas Health Science Center may use as a basis for reporting indigent care statistical samples derived from indigent care determinations made by their affiliated teaching hospitals and designed to estimate the amounts of charity care provided using the definitions established by The University of Texas hospitals noted above.7. Physician Practice Plan Upper Payment Limit.Any amounts received by the Physician Practice Plan from Upper Payment Limit shall be counted as payments received forunsponsored charityuncompensated care.