Directed Payment Program for Behavioral Health Services

Overview

The Directed Payment Program for Behavioral Health Services (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.

Texas Response to CMS Round 1 Questions for SFY 2023 DPP BHS (April 21, 2022) (.pdf)
Texas Response to CMS Round 2 Questions for SFY 2023 DPP BHS (May 16, 2022) (.pdf)
Texas Response to CMS Round 3 Questions for SFY 2023 DPP BHS (June 8, 2022) (.pdf)
Texas Response to CMS Round 4 Questions for SFY 2023 DPP BHS (July 8, 2022) (.pdf)
Texas Response to CMS Round 5 Questions for SFY 2023 DPP BHS (July 28, 2022) (.pdf)
CMS Renewal Approval Letter for SFY 2023 DPP BHS (August 1, 2022) (.pdf)
CMS DPP for BHS Amendment Approval Letter (August 10, 2022) (.pdf)
DPP for BHS Approval Letter (Nov. 15, 2021)

Methodology/Rules

The Texas Health and Human Services Commission (HHSC) adopted rules, 1 Texas Administrative Code (TAC) Section §353.1320, concerning Directed Payment Program for Behavioral Health Services; and §353.1322, concerning Quality Metrics for the Directed Payment Program for Behavioral Health Services. The new rules were published in the April 16, 2021 issue of the Texas Register and become effective on April 21, 2021.

Pre-Print Packages

State Fiscal Year 2024 (Year 3)

Enrollment

The Texas Health and Human Services Commission (HHSC) collected enrollment applications for DPP from February 1, 2023, through February 21st, 2023. Enrollment is now closed.

Component 1 Scorecards

Component 1 (65% of the DPP for BHS funding) is a uniform dollar increase paid prospectively on a monthly basis. CMHCs/LBHAs with CCBHC certification and CMHCs/LBHAs without CCBHC certification are eligible to participate in Component 1. MCOs must make HHSC-calculated payments to a DPP for BHS provider in accordance with the scorecard.

View the DPP for BHS SFY 24 (Year 3) September Component 1 Scorecard (.xlsx) (Updated 09/15/2023)

SFY 24 (Year 3) October Scorecard (.xslx) (Updated 10/16/2023)

SFY 24 (Year 3) November Scorecard (.xslx) (Updated 11/15/2023)

Component 2 Rate Increase Percentages

Component 2 (35% of the DPP BHS funding) is a uniform rate increase applied to the following CPT codes 90791, 90792, 90832, 90834, 90837, 90847, 96372, 99212, 99213, 99214, 99215, H0004, H0005, H0020, H0034, H2011, H2014, H2017, H2035, T1017. LBHAs/CMHCs with CCBHC certification and LBHAs/CMHCs without CCBHC certification otherwise eligible to participate in DPP BHS and enrolled with an MCO for the delivery of Medicaid covered benefits are eligible to participate in Component 2.

View DPP for BHS SFY24 (Year 3) Sept – Aug Component 2 Rate Increases Percentages by NPI (.xlsx) (Updated 09/15/2023)

Suggested IGT

Suggested Intergovernmental Transfer (IGT) amounts per SDA and provider for the first and second six months of IGT is available here (.pdf), and excel file can be located here (.xlsx). (Updated 11/03/2023)

The modeling is available here (.pdf), and the excel can be located here (.xlsx) (Updated 11/06/2023)

IGT Declaration of Intent form is available can be located here (.xlsx).( Updated 05/17/2023)

State Fiscal Year 2023 (Year 2)

Enrollment

The Texas Health and Human Services Commission (HHSC) collected enrollment applications for DPP BHS from March 2, 2022 through March 29, 2022. Enrollment is now closed.

View of list of Year 2 DPP BHS Provider IDs (.pdf)

Suggested IGT

1st 6 Months Suggested Intergovernmental Transfer (IGT) amounts per SDA and provider is available here (.pdf), and excel file can be located here (.xlsx). (Updated 06/01/2022)

The modeling is available here (.pdf), and the excel can be located here (.xlsx) (Updated 06/01/2022)

IGT Declaration of Intent form is available here (.pdf), and excel file can be located here (.xlsx).(Updated 05/16/2022)

HHSC also updated the projected payments and IGT amounts to reflect the final actuarial trend factors. Updated modeling is located here (.pdf), and an excel file can be located here (.xlsx.) (Updated 06/16/2022).

2nd 6 Months Suggested IGT amounts per SDA and provider is available here (.pdf), and the excel file can be located here (.xlsx). (Updated 11/08/2022)

Component 1 Scorecards

View DPP for BHS SFY23 (Year 2) September Scorecard (.xlsx) (Updated 09/15/2022)

View DPP for BHS SFY23 (Year 2) October Scorecard (.xlsx) (Updated 10/17/2022)

View DPP for BHS SFY23 (Year 2) November Scorecard (.xlsx) (Updated 11/15/2022)

View DPP for BHS SFY23 (Year 2) December Scorecard (.xlsx) (Updated 12/15/2022)

View DPP for BHS SFY23 (Year 2) January Scorecard (.xlsx) (Updated 01/17/2023)

View DPP for BHS SFY23 (Year 2) February Scorecard (.xlsx) (Updated 2/15/2023)

View DPP for BHS SFY23 (Year 2) March Scorecard (.xlsx) (Updated 3/15/2023)

View DPP for BHS SFY23 (Year 2) April Scorecard (.xlsx) (Updated 04/17/2023)

View DPP for BHS SFY23 (Year 2) May Scorecard (.xlsx) (Updated 05/15/2023)

View DPP for BHS SFY23 (Year 2) June Scorecard (.xlsx) (Updated 06/15/2023)

View DPP for BHS SFY23 (Year 2) July Scorecard (.xlsx) (Updated 07/15/2023)

View DPP for BHS SFY23 (Year 2) August Scorecard (.xlsx) (Updated 8/15/2023)

Component 2 Rate Increase Percentages

Component 2 (35% of the DPP BHS funding) is a uniform rate increase applied to the following CPT codes: 90791, 90792, 90834, 90837, 90839, 92507, 92523, 92526, 97110, 97530, 99213, 99214, 99215, H0020, H0034, H2011, H2014, H2017, T1017, Q3014. LBHAs/CMHCs with CCBHC certification and LBHAs/CMHCs without CCBHC certification otherwise eligible to participate in DPP BHS and enrolled with an MCO for the delivery of Medicaid covered benefits are eligible to participate in Component 2.

View DPP for BHS SFY23 (Year 2) Sept – Aug Component 2 Rate Increases Percentages by NPI (.xlsx) (Updated 09/15/2022)

State Fiscal Year 2022 (Year 1)

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 (.xlsx)).

Enrollment

The Texas Health and Human Services Commission (HHSC) collected enrollment applications for DPP BHS from March 24, 2021, through April 13, 2021 for eligibility period September 1, 2021 to August 31, 2022. The enrollment period is now closed.

Reconciliation – SFY22

As required by TAC 353.1320 , HHSC has completed the annual reconciliation for Component 1 to actual Medicaid utilization during the program period. All providers met conditions of participate in FY2022 for DPP BHS.

Detailed reconciliation files are available here (.pdf) and here (.xlsx).

Suggested IGT

Suggested Intergovernmental Transfer (IGT) amounts per SDA and provider is available here (.pdf), and excel file can be located here (.xlsx). (Updated 05/17/2021)

The modeling is available here (.pdf), and the excel can be located here (.xlsx) (Updated 05/17/2021)

The IGT Commitment form is available here (.pdf), and excel file can be located here (.xlsx).

Component 1 Scorecards

Component 1 (65% of the DPP for BHS funding) is a uniform dollar increase paid prospectively on a monthly basis. CMHCs with CCBHC certification and CMHCs without CCBHC certification are eligible to participate in Component 1. MCOs must make HHSC-calculated payments to a DPP for BHS provider in accordance with the scorecard.

View DPP for BHS SFY22 (Year 1) Sept – Jan Scorecard (.xlsx)

View DPP for BHS SFY22 (Year 1) Feb Scorecard (.xlsx)

View DPP for BHS SFY22 (Year 1) March Scorecard (.xlsx)

View DPP for BHS SFY22 (Year 1) April Scorecard (.xlsx)

View DPP for BHS SFY22 (Year 1) May Scorecard (.xlsx)

View DPP for BHS SFY22 (Year 1) June Scorecard (.xlsx)

View DPP for BHS SFY22 (Year 1) July Scorecard (.xlsx)

View DPP for BHS SFY22 (Year 1) August Scorecard (.xlsx)

Component 2 Rate Increase Percentages

Component 2 (35% of the DPP BHS funding) is a uniform rate increase applied to the following CPT codes: 90791, 90792, 90834, 90837, 96372, 99213, 99214, 99215, H0005, H0020, H0034, H2011, H2014, H2017, T1017. CMHCs with CCBHC certification and CMHCs without CCBHC certification otherwise eligible to participate in DPP BHS and enrolled with an MCO for the delivery of Medicaid covered benefits are eligible to participate in Component 2.

View DPP for BHS SFY22 (Year 1) Sept – August Component 2 Rate Increases Percentages by NPI(.xlsx) (Updated 09/15/2022)

View DPP for BHS SFY23 (Year 3) Sept – Aug Component 2 Rate Increases Percentages by NPI (.xlsx) (Updated 09/15/2023)