Provider Finance Communications

Overview

The information included on this webpage includes communications sent out by HHSC Provider Finance (formerly Rate Analysis), meeting materials, GovDelivery archives and other reference information. Any questions should be directed to ProviderFinanceDept@hhs.texas.gov.

Announcements

Ambulance Provider Average Commercial Rate (ACR) Application

Enrollment for the Enhanced supplemental payment program will begin on April 14, 2021. The application is available here. A PDF version of the application is available here (PDF). The Reimbursement Methodology for Ambulance Services rule is available here (PDF).

HHSC Publishes IGT Deadlines for Directed Payment Programs

HHSC is providing the first intergovernmental transfer (IGT) due dates and other related deadlines for the state fiscal year 2022 directed payment programs here. The IGT due dates published are for the first half of IGT only. HHSC will publish the IGT due dates for the second half of IGT in the upcoming future.

Effective September 1, 2021, HHSC will operate five directed payment programs: 

• Comprehensive Hospital Increase Reimbursement Program (CHIRP)
• Texas Incentives for Physician and Professional Services (TIPPS)
• Quality Incentive Payment Program (QIPP)
• Rural Access to Primary and Preventive Services (RAPPS)
• Directed Payment Program for Behavioral Health Services (DPP for BHS)

Additional information about the directed payment programs is available on the HHSC web site.

HHSC Models Estimated Hospital Program Payments for Federal Fiscal Year 2021 and 2022

HHSC has received many inquiries asking about the total impact of the modeled CHIRP and FFS payments on the DSH and UC payments.  While the models for both program are illustrative only and actual payments would be subject to actual enrollment, approval by CMS, and other decisions that have not yet been made, HHSC has modeled the impact on DSH and UC payments if payments are made as modeled. HHSC has modeled the DSH and UC payments two ways – first with only CHIRP included in the state payment cap or hospital specific limits and second with both CHIRP and the FFS supplemental payment program payments included in the state payment cap or hospital specific limit calculations.  At the beginning of the visualizations, there are a few graphics showing the change in DSH and UC payments from the inclusion of the FFS payments in the state payment cap or hospital specific limit. The remaining visualizations focus on modeling total program payments with the inclusion of the FFS payments in the state payment cap or hospital specific limit.  HHSC has not yet decided whether the proposed FFS supplemental payment program will include a quality incentive arrangement, which may influence whether the payment must be applied to the SPC or HSL.  HHSC looks forward to finalizing the proposal for the FFS supplemental payment program that was announced last week and continuing to work with all providers to explore financial solutions that support Texans access to high quality care. A copy of the model can be found here (.pdf) and here (.xslx), and the summary of the visualizations are posted here (.pdf).

Rural Access to Primary and Preventive Services (RAPPS)

Enrollment Opens for New Program for Rural Health Clinics

The enrollment period is now open for the Texas Health and Human Services Commission’s (HHSC) new Rural Access to Primary and Preventive Services (RAPPS) program. Applications are for the program period from September 1, 2021 to August 31, 2022. 

Interested rural health clinics are encouraged to complete the RAPPS application, which has two parts: (1) Rural Health Clinic Information; (2) Certification. It should take about 10 minutes to complete. The application must be submitted by 5:00 PM on April 13, 2021. Extensions will not be granted, and late applications will not be accepted. 

What is RAPPS?

RAPPS is a new program for rural health clinics (RHCs) to incentivize them to provide primary and preventive services for Medicaid-enrolled individuals in rural areas of the state. RAPPS payments will be included in MCO capitation rates and distributed through two components to enrolled RHCs who meet program requirements. RAPPS is a directed payment program that must be approved annually by the Centers for Medicare and Medicaid Services (CMS).

RAPPS Modeling Available

To assist potential applicants, HHSC has drafted a model of the potential earnings of RHCs under the RAPPS program. Please note: the modeling is only an example and does not reflect the final program values. The program values in the model are subject to changes based on the actual enrollment, data changes, and approval issued by CMS. The proposed RAPPS modeling is available here (.pdf) (excel version of the file here (.xslx)). 

RAPPS Quality Information

HHSC has posted the updated RAPPS reporting and achievement requirements here (.pdf) and quality measure specifications here (.xslm). These documents include additional information for quality measurement and are subject to CMS approval. If you have questions about the measures, please email DPPQuality@hhs.texas.gov.

Directed Payment Program for Behavioral Health Services (DPP for BHS)

Enrollment Opens for new Program for Community Mental Health Centers 

The enrollment period is now open for the Texas Health and Human Services Commission’s (HHSC) new directed payment program for Behavioral Health Services (DPP BHS). Applications are for the program period from September 1, 2021 to August 31, 2022. 

Community Mental Health Centers (CMHCs) are encouraged to complete the DPP BHS application, comprised of the following sections: (1) Community Mental Health Center Information; (2) Quality Questions; (3) Certification. It should take about 15 minutes to complete. The application must be submitted by 5:00 PM on April 13, 2021. No extensions beyond the due date will be provided. Any application submitted after the due date will not be accepted. 

What is DPP BHS?

DPP BHS is a new value-based payment program for CMHCs to incentivize them to continue providing services to Medicaid-enrolled individuals that are aligned with the Certified Community Behavioral Health Clinic (CCBHC) model of care. The program will continue successful Delivery System Reform Incentive Payment (DSRIP) innovations by CMHCs to promote and improve access to behavioral health services, care coordination, and successful care transitions. DPP BHS payments will be included in MCO capitation rates and distributed through two components to enrolled CMHCs who meet program requirements. DPP BHS must be approved by the Centers for Medicare and Medicaid Services (CMS).

DPP BHS Modeling

To assist potential applicants, HHSC has drafted a model of the potential earning of each CMHC under the program. Please note: the modeling is only an example and does not reflect the final program values. The program values in the model are subject to change based on the actual enrollment, data changes, and approval issued by CMS. The proposed DPP BHS modeling is available here (.pdf) (excel version of the file here (.xslx)).

DPP BHS Quality Information

HHSC has posted the updated DPP BHS reporting and achievement requirements here and quality measure specifications here. These documents include additional information for quality measurement and are subject to CMS approval. HHSC has also summarized stakeholder feedback on the proposed measures and performance requirements here. If you have questions about the measures, please email DPPQuality@hhs.texas.gov.

Notice of Public Hearing on Proposed Rule for the Public Health Provider – Charity Care Program

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on March 26, 2021, at 11:30 a.m. CDT, to receive public comments on the proposed rule for the Public Health Provider – Charity Care Program (PHP-CCP). Persons interested in attending may register for the public hearing here. Please click here (.pdf) for more information.

HHSC Announces Intent to Develop a Fee-for-Service Supplemental Payment Program for Certain Hospital Services

HHSC is releasing modeling of potential options to create a new fee-for-service (FFS) supplemental payment program for certain hospital services.  HHSC intends to create this program to continue the financial transition for providers who have historically participated in the Delivery System Reform Incentive Payment program. We continue to work on solutions to preserve the financial resources many of our hospitals depend on to provide access and quality care to Medicaid clients and the uninsured.  The FFS program would be created, subject to approval by the Centers for Medicare and Medicaid Services (CMS), through the Medicaid state plan.  State plan programs and services do not impact 1115 Waiver budget neutrality. The initial program design includes publicly-owned and -operated hospitals only.  Options considered by HHSC include payments up to the Medicare upper payment limit (UPL), up to the estimate of what an average commercial payer would have paid (a.k.a. the average commercial reimbursement (ACR) UPL), or the greater of the Medicare UPL or ACR UPL). HHSC plans to initiate rulemaking this spring with a proposed effective date for the program of October 1, 2021.  A copy of the model can be found here (.pdf).

Comprehensive Hospital Increase Reimbursement Program (CHIRP)

HHSC Adopts New Rules for CHIRP

HHSC is adopting new §353.1306, concerning Comprehensive Hospital Increase Reimbursement Program for program periods on or after September 1, 2021; and new §353.1307, concerning Quality Metrics and Required Reporting Used to Evaluate the Success of the Comprehensive Hospital Increase Reimbursement Program. The new rules will be published in the March 26, 2021 issue of the Texas Register and become effective on March 28, 2021.

The new rules establish the Comprehensive Hospital Increase Reimbursement Program (CHIRP), the successor to the Uniform Hospital Rate Increase Program, and apply to program periods on or after September 1, 2021. CHIRP is a statewide program that provides for increased Medicaid payments to hospitals for inpatient and outpatient services provided to persons with Medicaid. Texas Medicaid managed care organizations (MCOs) receive additional funding through their monthly capitation rate from HHSC and are directed to increase payment rates for participating hospitals. As designed, eligible hospitals receive a percent increase paid on claims submitted to a Medicaid MCO. CHIRP’s purpose is to advance goals and objectives in the state’s Medicaid quality strategy by incentivizing improved quality and access for hospitals that serve persons with Medicaid.

The adoption preamble is available here (.pdf), and the final rules are available here (.pdf)

CHIRP Modeling

HHSC is providing the CHIRP modeling for example purposes only; these are not the final program values. The program values are subject to changes based on actual enrollment, data changes and approval issued by the Centers for Medicare and Medicaid Services (CMS). The CHIRP modeling is updated to reflect the final rules and is available here (.pdf) (excel version of the file here (.xslx)) and the summary visualizations of the modeling are available here (.pdf).  

HHSC Posts Frequently Asked Questions for CHIRP Application

View the frequently asked questions (.pdf) from stakeholders regarding the application for the Comprehensive Hospital Increase Reimbursement Program (CHIRP). 

CHIRP Enrollment

Enrollment for CHIRP began on March 15, 2021. The Application is available here. A PDF version of the application is available here (.pdf).

Texas Incentives for Physician and Professional Services (TIPPS) Program

HHSC Adopts New Rules for TIPPS

The Health and Human Services Commission (HHSC) is adopting new §353.1309, concerning Texas Incentives for Physicians and Professional Services, and new §353.1311, concerning Quality Metrics for the Texas Incentives for Physician and Professional Services Program. The new rules will be published in the March 12, 2021 issue of the Texas Register and become effective on March 21, 2021.

The new rules establish the Texas Incentives for Physician and Professional Services (TIPPS) Program and describe the circumstances under which HHSC will direct a Medicaid managed care organization (MCO) to provide a uniform per member per month payment, certain incentive payments, and a uniform percentage rate increase to physician groups in the MCO's network in a participating service delivery area for the provision of physician and professional services.

The adoption preamble is available here (.pdf), and the final rules are available here (.pdf)

TIPPS Modeling

HHSC is providing the TIPPS modeling for example purposes only; these are not the final program values. The program values are subject to changes based on actual enrollment, data changes and approval issued by the Centers for Medicare and Medicaid Services (CMS). The TIPPS modeling is updated to reflect the final rules and is available here (.pdf) (excel version of the file here (.xslx)).

TIPPS Enrollment

Enrollment for the TIPPS program began on March 15, 2021. The Application is available here. A PDF version of the application is available here (.pdf).

Monitoring Plan for Local Funds Used to Support Medicaid Payments

To increase oversight of local funds used as the non-federal share, the Health and Human Services Commission (HHSC) is proposing to implement a process to monitor the financing structures that underlie the local funding. This effort is part of HHSC’s initiative in the Blueprint for a Healthy Texas to improve accountability and sustainability of supplemental and directed payment programs to achieve positive outcomes. 

The Draft Monitoring Plan for Local Funds Used to Support Medicaid Payments (.pdf) is published for public comment on October 22, 2020. Comments will be accepted until 5 p.m. on November 12, 2020 and can be sent by email to RAD_1115_Waiver_Finance@hhsc.state.tx.us.

GovDelivery Archives

Provider Finance has begun to use the GovDelivery communications system for routine and non-routine alerts and announcements regarding rate hearing schedules and other important information. To begin receiving GovDelivery alerts from HHS Provider Finance, please:
1.    Visit the HHS GovDelivery registration site;
2.    Select Medicaid Reimbursement Rates and Non-Medicaid Reimbursement Rates as preferences; and 
3.    Enter the other requested information.

Provider Reimbursement Tables (.pdf) (Sent 11/05/2020)

Proposed Medicaid Payment Rates for the Medicaid Biennial Calendar Fee Review (.pdf) (Sent 11/02/2020)

HHSC Requests Comments on Draft Monitoring Plan for Local Funds (.pdf) (Sent 10/22/2020)

Foster Care Rates Methodology Study (.pdf) (Sent 09/28/2020)

Upcoming Deadline for RMTS Staff Roster Submissions (.pdf) (Sent 09/14/2020)

Healthcare Common Procedure Coding System (HCPCS) Updates (.pdf) (Sent 09/09/2020)

Rural Hospital Proposed Standard Dollar Amounts Realignment (.pdf) (Sent 09/08/2020)

Meeting Materials Available from 08-14-2020 Provider Finance Stakeholder Meeting (.pdf) (Sent 09/02/2020)

Provider Relief Fund - Application Deadline Extended Until 09-13-2020 (.pdf) (Sent 09/01/2020)

Provider Relief Fund - Application Deadline Extended Until 08-28-2020 (.pdf) (Sent 08/04/2020)

Provider Relief Fund - Application Deadline Extended Until 08-03-2020 (.pdf) (Sent 07/22/2020)

Provider Relief Fund - Application Deadline Notification (.pdf) (Sent 07/15/2020)

COVID-19 Medicaid Rate Notifications (.pdf) (06/22/2020)

Meeting Information

Materials from the August 14th stakeholder meeting:

View the Webinar Recording (.wmv) (8-14-2020)
View the Webinar Presentation (.pdf) (8-14-2020)
View the Webinar Frequently Asked Questions (.pdf) (8-14-2020)