Hospitals & Clinic Services

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

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

SB 809 / Rider 143 COVID-19 Reporting Healthcare Institution List (Updated 11/17/2022)

SB809/Rider 143 Submission List as of November 15, 2022

The Health and Human Services Commission (HHSC) has posted the list of healthcare institutions who must submit reports in compliance with Senate Bill 809 or Rider 143. The list shows providers who haven’t submitted a SB 809 / Rider 143 Report as well as those HHSC staff are helping complete the report. The list can be found here (xlsx).This list was updated with completed reports received by November 15, 2022.

Note that this list is derived at a point in time and not all inclusive as providers may enroll or change at various times. Any provider that is identified as a “Health Care Institution” defined in Section 74.001 of the Civil Practice and Remedies Code is required to complete the reports. The list has been updated to align with licensing agencies. All questions related to SB 809 / Rider 143 should be emailed to HHSC_RAD_Survey@hhs.texas.gov. There may be a delay in response due to volume.

HHSC has the authority to pursue disciplinary actions for facilities that fail to report. The health and safety of those we serve is always our top priority.

The first quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published March 1, 2022 and can be found here.

The second quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published June 1, 2022 and can be found here.

The third quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published September 1, 2022 and can be found here.

SB 8, from the 87th Legislature’s third special session, authorizes grants to rural hospitals, nursing homes, home health agencies, intermediate care facilities and community attendants from the Coronavirus State Fiscal Recover Fund, established under the American Rescue Plan Act. We are required to prioritize grants to grantees who are compliant with the reporting requirements identified above. Failure to submit reports required by Senate Bill 809 or Rider 143 could limit the funding a provider may receive from the grants or disqualify them completely. Providers must submit an Initial Form, which includes funding and cost data covering the period January 2020 through August 2021. If you are delinquent in submitting the Initial Form, please email us at HHSC_RAD_Survey@hhs.texas.gov. Providers must also submit this monthly form every month. The reports are due one month after the reporting period ends. (for example, the report for December 2021 data will be due Feb. 1).

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

Monthly SB 809 / Rider 143 COVID-19 Reporting (Updated 02/25/2022)

November 8, 2021 Update:

The 87th Texas Legislature directed the Health and Human Services Commission (HHSC) to report federal COVID-19 funding from specific health care institutions, and certain costs those providers have spent related to COVID-19 public health emergency. HHSC has developed a monthly report to obtain the information required by Rider 143 (.pdf) (2022-23 General Appropriations Act, Senate Bill (S.B.) 1, 87th Legislature, Regular Session, 2021 (Article II, HHSC, Rider 143) and S.B. 809 (.pdf) (87th Legislature, Regular Session, 2021). 

Frequently Asked Questions (FAQ):

View the HHSC created list of “frequently asked questions ” (FAQ) (.pdf) (Updated 03/18/2022) with the answers to common questions to assist providers in completing the report.

Reporting: 

Providers must submit an Initial Form, which includes funding and cost data covering the period January 2020 through August 2021. If you are delinquent in submitting the Initial Form, please contact us at HHSC PFD Survey. The ongoing monthly reports (located here) will be ongoing and will cover a single month; each monthly report will be due on the 1st of the second following month following the end of the month (for example, the report for January 2022 data will be due March 1, 2022.)

For those providers with multiple submissions, the offline form here (.xlsx) can be used. Do not change the format in any way as this might cause your information to not be submitted. Complete the questions that apply to your specific provider type and send to HHSC_RAD_Survey@hhs.texas.gov once complete.

You will receive a confirmation page once your report has been fully completed and submitted. No email confirmation will be sent.

A pdf version of the ongoing report is available here (.pdf) for review prior to submitting the reports.

If you are unable to meet the reporting deadline, please contact the Provider Finance Department at HHSC_RAD_Survey@hhs.texas.gov for assistance.

Failure to submit:

Failure to complete and/or submit the required monthly report(s) on-time will result in:

A report to the Department of State Health Services or HHSC Regulatory Services and potential adverse actions on your licensure and/or  HHSC may initiate payment holds for providers who fail to submit the required monthly reports.

List of Providers Required to Complete Reports: 

The following entities are required to complete the report:

  • Ambulatory Surgical Centers;
  • Assisted Living Facilities licensed under Chapter 247, Health and Safety Code;
  • Emergency Medical Services Providers;
  • Health Services Districts created under Chapter 287, Health and Safety Code;
  • Home and Community Support Services Agencies;
  • Hospice Providers;
  • Hospitals;
  • Hospital Systems;
  • Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID);
  • Community Living Assistance and Support Services (CLASS) or Case Management Agency (CMA) Providers;
  • Deaf-Blind with Multiple Disabilities (DBMD) Providers;
  • Home and Community-Based Services (HCS) Providers;
  • Texas Home Living (TxHmL) Providers;
  • Nursing Facilities; and
  • End-Stage Renal Disease Facilities licensed under Section 251.011, Health and Safety Code

Please email the HHSC Provider Finance Survey for assistance at HHSC_RAD_Survey@hhs.texas.gov.

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 Rate Analysis Division website at https://rad.hhs.texas.gov/hospitals-clinic/hospital-services/uncompensated-care.

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.

Programs and Services

Clinic and Facility Services

Hospital Services

Other Reporting