Overview
The Health and Human Services Commission (HHSC) Provider Finance Department (PFD) for Hospital Services develops reimbursement methodology rules for determining payment rates/fees for Medicaid Hospital Services. General Medicaid program rules for Hospital Services are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter A, Division 10, Rule §354.1121. Additional general Medicaid program rules for Hospital Services are located at Title 1 of the Texas Administrative Code, Part 15, Chapter 354, SubChapter A, Division 11, Rules 1131-1190. HHSC PFD for Hospital Services develops payment rates/fees in accordance with published rules and policy guidelines for Hospital Services.
Announcements
- Executive Order GA-46 Reporting for Collection of Information on Hospital Costs Related to Immigration Status
In accordance with Executive Order No. GA-46, issued by Governor Greg Abbott on August 8, 2024, hospital providers must ask each patient during the hospital intake process whether the patient is (1) a citizen or an alien lawfully present in the United States, or (2) an alien not lawfully present in the United States. Hospital providers must report to HHSC quarterly the number of inpatient discharges of and emergency visits by all patients and patients who are (1) a citizen or an alien lawfully present in the United States, and (2) an alien not lawfully present in the United States. Hospital providers must also report to HHSC quarterly the costs of care for patients who are not lawfully present in the United States. Hospitals are expected to begin collecting the information by November 1, 2024, and begin reporting to HHSC on March 1, 2025.
When collecting information about a patient’s immigration status, hospital providers must provide notification that, as required by federal law, the response will not affect patient care.
See the initial draft of the spreadsheet to be used to collect data here (.xlsx).
This spreadsheet is designed to provide guidance as to what information acute-care hospitals will need to be able to track, collect, and report so that you can begin making any necessary system adjustments in advance of November 1, 2024. As indicated in the executive order, reporting will be done by month, on a quarterly basis. The bulleted list below outlines how the reporting will be done:
- March 1, 2025 – Information for September, October, November due (for this first year there will be no reporting for September or October).
- June 1, 2025 – Information for September through February due.
- September 1, 2025 – Information for September through May due.
- December 1, 2025 – Information for September through August will be due.
- January 1, 2026 – HHSC will provide report to the Governor, Lt. Governor, and Speaker of the House on the proceeding years costs.
Each time data is submitted, information will need to be provided for all applicable months. This means data for previously reported months will need to be updated and/or provided again as appropriate. We will provide further guidance in the coming weeks to specify how this information will be reported to HHSC.
- Rider 150: Semi-Annual COVID-19 Reporting for Nursing Facilities and Hospitals (updated 07/23/2024)
Nursing facilities and hospitals must submit semi-annual COVID-19 federal fund reports in accordance with the 2024-25 General Appropriations Act, House Bill 1, 88th Legislature, Regular Session, 2023 (Article II, HHSC, Rider 150).
The reporting schedule is as follows:- Due Mar. 1, 2024: data for Sep. 1, 2023 – Jan. 31, 2024
- Due Sep. 1, 2024: data for Feb. 1, 2024 – Jul. 31, 2024
- Due Mar. 1, 2025: data for Aug. 1, 2024 – Jan. 31, 2025
Only nursing facilities and hospitals are subject to this reporting requirement; other health care institutions are not subject to this Rider 150 reporting requirement.
The update to the reporting requirement is reflected in an amendment to Texas Administrative Code, Title 1, Part 15, Chapter 355, Subchapter I, Section 355.7201, concerning Novel Coronavirus (COVID-19) Fund Reporting. The rule text and preamble is available here (pdf).
Instructions:
There are two ways to submit the Rider 150 report.
- To submit on behalf of multiple hospitals and/or nursing facilities that received $0 during the reporting period: submit the Authorized Representative Designation document. To do so, complete this spreadsheet (.xlsx) and email it to HHSC_RAD_Survey@hhs.texas.gov.
- To submit on behalf of an individual hospital or nursing facility: Submit the form at this link. You will receive a confirmation page once your report is submitted; no email confirmation will be sent.
If you have any questions about this required reporting for nursing facilities and hospitals, please contact the Provider Finance Department at HHSC_RAD_Survey@hhs.texas.gov.
- RH-CHRG Tier 1 Direct Award: Awarded Funds Utilization Report
Awarded Funds Utilization Report Required for All RHs That Received Direct Awards
The Texas Health and Human Services Commission (HHSC) completed disbursement of the Noncompetitive Direct Awards for the Rural Hospitals in Healthcare Relief Grant (RH-CHRG) program as directed by Senate Bill 8, 87th Legislature, 3rd Called Session, 2021.
Each Rural Hospital (RH or Beneficiary) that received noncompetitive direct award funds ($250,000 per RH) under through the Rural Hospital COVID-19 in Healthcare Relief Grant (RH-CHRG) Tier 1 is required to complete this Awarded Funds Utilization Report (referred to as "Report" hereafter) by October 31, 2022 at 5:00p.m. CDT, the due date outlined in Section VI. Reporting Requirements of the Contract.
Click HERE for the report.
Click HERE for a (.pdf) of the questions.
Each individual Report submission should reflect the individual RH that received the $250,000 award. If a legal entity owns multiple RH's that received an award under Tier 1, then that legal entity must submit multiple Reports: one Report for each RH license number.
Click HERE (.xlsx) for a list of received reports. Data as of October 31, 2022 at 5:00 p.m. CDT
Recoupments:
In accordance with Section IV of Attachment A: Statement of Work, HHSC may recoup up to the full amount of $250,000 in the event of the following: 1. the Beneficiary does not submit the completed Report by the deadline; or 2. HHSC determines that Beneficiary did not appropriately utilize the funds in accordance with the Statement of Work and the terms of the Contract. If the Beneficiary has not expended 100% of the funds awarded under this noncompetitive direct award program at the time of Report submission, then HHSC may recoup the amount that has not been spent.
If the Beneficiary undergoes a permanent closure prior to the deadline of the Report:
The Beneficiary will receive direct communications from HHSC Provider Finance regarding the completion of this Report.
Tips for completing this report:
- * indicates a required field.
- This Report is required for each individual RH that received a $250,000 RH-CHRG Noncompetitive Direct Award.
- Each RH's license number and RH-CHRG Noncompetitive Direct Award Contract Number will be needed for this Report.
- Refer to your copy of Attachment A: Statement of Work for more details about the purpose of this Report.
- This Report is NOT related to the competitive awards under RH-CHRG Tier 2 (RFA# HHS0011335).
Thank you!
HHSC Provider Finance Department
ProviderFinanceDept@hhs.texas.gov
- 2022 COVID-19 Grant Programs
December 16, 2021
Pursuant to Senate Bill (S.B.) 8, 87th Legislature, 3rd Called Session, 2021, the Health and Human Services Commission will administer one-time grants for the following providers:
- $75,000,000 million for rural hospitals (S.B. 8, Section 12);
- $38,000,000 ($250,000 per rural hospital) via direct grant awards;
- $37,000,000 distributed via a competitive grant process;
- $200,000,000 for nursing facilities (S.B. 8, Section 33);
- $90,000,000 ($75,000 per licensed facility) in direct grant awards;
- $110,000,000 distributed via a competitive grant process;
- $178.3 million for assisted living facilities, home health agencies, intermediate care facilities for individuals with intellectual and developmental disabilities or related conditions, and providers of community attendant services (S.B. 8, Section 33) distributed via a competitive grant process.
More information will be published at the following link under “COVID-19 in Healthcare Relief Grants” as it becomes available: https://www.hhs.texas.gov/business/grants/grants-awarded-hhs
- $75,000,000 million for rural hospitals (S.B. 8, Section 12);
eFMAP Notification
The Families First Coronavirus Response Act, which became federal law on March 18, 2020, authorized an increase of 6.2 percentage points to the Federal medical assistance percentage (FMAP) determined for each state for each calendar quarter occurring during the emergency period. The federal government’s share of most Medicaid service costs is determined by the FMAP rate, which varies by state and is determined by a formula set in statute. An increased FMAP has the impact of increasing the amount of federal funds available for some Medicaid payments.
The Health and Human Services Commission (HHSC) received many inquiries asking how the enhanced FMAP (eFMAP) would impact supplemental and directed payment programs. Supplemental and directed payment programs are supported with a combination of federal and local funds through either certified public expenditures or intergovernmental transfers (IGT). After consultation with the Centers for Medicare and Medicaid Services (CMS) to understand how to apply the enhanced FMAP (eFMAP) to such programs, HHSC developed a plan for ensuring that funds previously transferred to the agency are applied to each applicable program in an efficient manner and with minimal administrative burden on local entities and providers.
The eFMAP will apply to state expenditures that were incurred on or after January 1, 2020, through June 30, 2020. The eFMAP may continue if the emergency period is extended beyond June 30, 2020. The eFMAP will be applied based upon the date the expenditure is incurred by the state as recorded on our CMS-64, regardless of whether the payments are made by HHSC to providers on an interim, supplemental, or per claim basis. With respect to any programs that use an interim or advanced payment methodology, the FMAP that is applied will be based upon the date the state recorded the expenditure on the CMS-64, and any reconciliations performed will be recorded as adjustments to the prior period.
Detailed information about the impacts on each supplemental and directed payment program can be found here.
If you have any questions, please contact RAD_Payments@hhsc.state.tx.us.
Section 1115 Waiver Protocol Approved by CMS
HHSC has released the final revised Texas Uncompensated Care payment protocol that was submitted approved by the Centers for Medicare and Medicaid Services (CMS) on July 26, 2018. Many stakeholders provided valuable feedback to HHSC on the preliminary on the preliminary working draft of the protocol that was released on February 23, 2018.
Texas is required by CMS to submit a revised protocol under Special Terms and Conditions (STC) for the Section 1115 Demonstration Waiver renewal. The STCs require an uncompensated care protocol that only allows for charity costs allowed under a provider’s charity policy (that that adhere to the charity care principles of the Healthcare Financial Management Association - Principles and Practices Board Statement 15: Valuation and Financial Statement Presentation of Charity Care and Bad Debts by Institutional Healthcare Providers) and also based on Medicare cost principles. The revised protocol was due to CMS no later than March 30, 2018. CMS had 90 calendar days to provide feedback to Texas, and subsequent changes were made based on that feedback. Failure to meet the March 30, 2018, deadline would have resulted in a 20% reduction in expenditure authority in the UC program.
This protocol should be read in conjunction with a number of accompanying draft Excel workbooks that are illustrative of how the procedures in the protocol are to be followed. These workbooks are for analysis purposes only and the data therein is not suitable for any other purpose. Further, these workbooks have not yet been approved by CMS and are subject to change. HHSC has posted the protocol and the draft Excel workbooks on the Provider Finance Department website at https://pfd.hhs.texas.gov/hospitals-clinic/hospital-services/uc-payments-protocol.
UHRIP
The Texas Health and Human Services Commission (HHSC) has approval from the Centers for Medicare and Medicaid Services (CMS) to implement the Uniform Hospital Rate Increase Program (UHRIP) for hospital services statewide. Further information on the UHRIP program may be obtained on our Uniform Hospital Rate Increase Program page.
SDA Add-On status verification is in process through July 27, 2017. Please review your SDA Add-On information and submit any changes on the Status Verification form.