Public Health Provider – Charity Care Program

Overview

The Texas Health and Human Services Commission (HHSC) is working to develop the Public Health Provider – Charity Care Program (PHP-CCP) that is designed to allow qualified providers to receive reimbursement for the cost of delivering healthcare services, including behavioral health services, immunizations, and other preventative services, when those costs are not reimbursed by another source. The program is authorized under the 1115 waiver. Year 1 of the program will consist of uncompensated care and Medicaid shortfall. In year 2, the program will transfer to charity care only. 

In accordance with the Special Terms and Conditions of the 1115 waiver, to participate in the program, providers must be funded by a unit of government able to certify public expenditures. Publicly-owned and operated providers eligible to participate include:

• Established under the Texas Health and Safety Code Chapters 533 and 534 and are primarily providing behavioral health services:

  • Community Mental Health Clinics (CMHCs)
  • Community Centers
  • Local Behavioral Health Authorities (LBHAs)
  • Local Mental Health Authorities (LMHAs)

• Local Health Departments (LHDs) and Public Health Districts (PHDs) established under the Texas Health and Safety Code Chapter 121

Beginning October 1, 2021, the PHP-CCP will be operational and allow certain providers to receive a supplemental payment for certain medical services. Payments from the pool are to defray the cost of uncompensated costs of providing medical services to Medicaid eligible or uninsured individuals. Total funding will not exceed 500 million (total computable) in each of the first two years of the program. In future years, this pool is subject to resizing based on actual charity care costs incurred by eligible providers.

Enrollment

HHSC will send an initial form to gauge interest in the program around July 2021. Note that this is not a requirement to be enrolled in PHP-CCP but will assist HHSC in developing an initial provider list. 

To participate in the program, an eligible provider must attend annual training prior to the program period start date (October 1, 20XX) and complete a cost report application within 45 days of the program period end date (September 30, 20XX). Each PHP-CCP program period is equal to a Federal Fiscal Year (FFY) beginning October 1 and ending September 30 of the following year.  

Methodology/Rules

HHSC proposed new §355.8215, concerning the PHP-CCP, which is published in the March 19, 2021 issue of the Texas Register. HHSC is proposing this new rule under the 1115 waiver to reimburse certain costs for qualifying providers associated with providing care, including behavioral health, immunizations, chronic disease prevention, and other preventative services for the uninsured. 

HHSC is accepting public comments on the proposed rule from March 19, 2021 through April 19, 2021. A public hearing was held on March 26, 2021, at 11:30 a.m. (CST) to receive public comments on the proposal. The recording of the hearing can be found here. Written comments may also be submitting via email to: PHP-CCP@hhs.texas.gov.