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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 consisted of uncompensated care and Medicaid shortfall. Effective year 2, the program has transitioned 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.

Federal Approval

On December 22, 2021, Texas Health and Human Services Commission (HHSC) received federal approval of the Public Health Providers – Charity Care Program (PHP-CCP) Protocol from the Center for Medicaid and Medicare Services (CMS).

Note: PHP-CCP will utilize an online cost reporting tool for the SFY23 submissions. 

Methodology/Rules

HHSC has adopted §355.8215, concerning the PHP-CCP, which is published in the Texas Administrative Code here. HHSC adopted this 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 adopted  §355.8217, concerning the PHP-CCP payments being available for eligible providers to help defray the uncompensated costs of charity care beginning October 1, 2022, which is published in the Texas Administrative Code here.

Year 1 (DY11) Uncompensated Care Trained Preparers

The initial cost report training was conducted in August 2021. Please note that an entity is eligible to submit the PHP-CCP cost reporting tool if at least one individual from their organization is on the Trained Preparer list.

Please find a copy of the training slides here (.pdf).

View the PHP-CCP Cost Reporting Tool Supporting Documentation Companion Guide and FTP User Guide here (.pdf).

Year 2 (DY12) Charity Care Transition 

Year 2 (DY12) of the PHP-CCP will transition from all uncompensated care to charity care only. Starting with Year 2 and subsequent years, providers will be required to create a charity care policy for their organization and submit their policy to HHSC in addition to the PHP-CCP Cost Reporting tool.

HHSC conducted cost report training webinars in preparation for Year 2 of the PHP-CCP program on August 15, 2023, August 22, 2023, and September 15, 2023. 

Per TAC §355.8217, providers are required to have at least one financial contact attend training annually. 
Cost report training is required annually by at least one financial contact to participate in the program. 

Year 2 of the PHP-CCP Cost report will utilize the State of Texas Automated Information Reporting System (STAIRS) for the collection of all cost reports beginning October 1st, 2023.  This online system will replace the excel spreadsheet cost report providers utilized in Year 1. 

Please review the STAIRS online cost reporting tool here.
View the Addendum to Attachment T (.pdf)

View the List of PHP-CCP Year 2 Authorized Preparers (.xlsx)

View the Charity Care Transition PowerPoint slides (.pdf)

View Charity Care Sample Policy 1 (.pdf)

View Charity Care Sample Policy 2 (.pdf)

View the Healthcare Financial Management Associated (HFMA) Hospital Charity Care and Financial Assistance Policy and Procedures (.pdf)

View the Healthcare Financial Management Associated (HFMA) Statement 15 (.pdf) – Valuation and Financial Statement Presentation of Charity Care, Implicit Price Concessions and Bad Debts by Institutional Healthcare Providers.

Please find a copy of the training slides here (.pdf).

Please reach out to PHP-CCP@hhs.texas.gov for additional information or questions.

Please call 737-867-7999 to speak with a PFD staff member regarding the PHP-CCP.