Directed Payment Program for Behavioral Health Services

The Directed Payment Program for Behavioral Health Services (DPP BHS) is a program for community mental health centers and local behavioral health authorities . Beginning September 1, 2024, all participants must be a Certified Community Behavioral Health Clinic (CCBHC). It is not a direct assistance program for Medicaid beneficiaries, but DPP BHS does provide funding to certain mental and behavioral health providers to encourage provider participation in Medicaid.

Overview

The Directed Payment Program for Behavioral Health Services (DPP BHS) is a value-based payment program for Community Mental Health Centers (CMHC) to incentivize the continuation of providing services to Medicaid-enrolled individuals 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. An update to §353.1320 was published in the January 19, 2024 issue of the Texas Register and became effective on January 25, 2024.

The rules are available here: §353.1320 and §353.1322.

New TAC updates effective January 2024: see preamble and rule text here (.pdf)

Pre-Print Packages

State Fiscal Year 2025 (Year 4)

Enrollment

The Texas Health and Human Services Commission (HHSC) collected enrollment applications for DPP BHS from February 1, 2024, through February 21, 2024. Enrollment is now closed.

Along with your application, please complete and submit this attachment to PFD_DPPBHS@hhs.texas.gov. This is to indicate your network status for SFY 2025 for all billing NPIs you wish to include in your application.

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 (.xlsx) (Updated 10/16/2023)

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

SFY 24 (Year 3) December Scorecard (.xlsx) (Updated 12/15/2023)

SFY 24 (Year 3) January Scorecard (.xlsx) (Updated 01/16/2024)

SFY 24 (Year 3) February Scorecard (.xlsx) (Updated 02/15/2024)

SFY 24 (Year 3) March Scorecard (.xlsx) (Updated 03/15/2024)

SFY 24 (Year 3) April Scorecard (.xlsx) (Updated 04/15/2024)

We were recently alerted to a potential concern from a provider involving payments not aligning with the anticipated scorecard payments.

Upon careful examination, it became apparent that there was a misalignment associated with the scorecard calculations and an adjustment was necessary to ultimately bring the scorecard payment process closer to the projected total payments. It is important to note that there will be an adjustment for the February scorecard, shown in the February Method Adjustment column, that reflects changes to the previous scorecards. The payments in the scorecard should reflect the normalized payments going forward.

We sincerely appreciate the understanding and cooperation of all our stakeholders as we work towards resolving this issue and improving our processes.

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 SFY23 (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)

Reconciliation – SFY23

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 participation in SFY2023 for DPP BHS.
The monthly scorecards issued for the program period required rounding based on caseload when calculating amounts; consequently, an eligibility adjustment is included in the reconciliation file to account for these remaining funds.
Detailed reconciliation files are available here (.pdf) and here (.xlsx).

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)

View BHS Year 2 First IGT Reconciliation (.xlsx)

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

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).

BHS Year 1 First IGT Reconciliation

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)