Hospitals & Clinic Services

Overview

The Texas 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 in 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 and fees in accordance with published rules and policy guidelines for Hospital Services.

Announcements

Executive Order GA-46 Reporting Form Available for Collection of on Hospital Costs Related to Immigration Status (Updated 4/9/2025)

UPDATE: As of April 9, 2025, HHSC has updated the Executive Order GA-46 Reporting Form. The updated version is available: Hospitals & Clinic Services Executive Order No. Ga-46 Form (.pdf).

Notable Modifications:

  • Added instruction page for clarification.
  • Removed the signature requirement
  • Added separate buttons for “Save” and “Submit” to improve clarity.
    • The save button will prompt you to save directly onto your PC.
    • The submit button will create an email to send the form directly to our email box: ga46.submission@hhs.texas.gov.

Be aware that some features of the form may not work in an internet browser. If the form opens in an internet browser, download or save it locally and open it in a PDF reader (Adobe).

When submitting updated data from the previous quarter, submit the total amount for each month. Also, indicate in the appropriate box that the form includes updates for the previous quarter.

Hospitals must submit the Executive Order GA-46 Form following the reporting timelines below:

  • Due March 1, 2025 – Information for Sept., Oct., and Nov. (For this first year, there will be no reporting for Sept. or Oct.).
  • Due June 1, 2025 – Information for Nov. through Feb.
  • Due Sept. 1, 2025 – Information for Nov. through May.
  • Due Dec. 1, 2025 – Information for Nov. through Aug.
  • Due Jan. 1, 2026 – HHSC will report to the Governor, Lt. Governor, and Speaker of the House on the preceding year’s costs.

In accordance with Executive Order No. GA-46 (.pdf), issued by Governor Greg Abbott on Aug. 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 quarterly to HHSC the number of inpatient discharges and emergency visits by all patients, including those 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 quarterly to HHSC the costs of care for patients not lawfully present in the United States. Hospitals began collecting this information on Nov. 1, 2024, and will begin reporting to HHSC on March 1, 2025.

When collecting information about a patient’s immigration status, hospital providers must provide notification that the response will not affect patient care, as required by federal law.

Information must be provided for all applicable months each time data is submitted. Therefore, data for previously reported months must be updated or provided again as appropriate.

ATLIS SFY 2025 First Half suggested IGT

Aligning Technology by Linking Interoperable Systems (ATLIS) Suggested Intergovernmental Transfer (IGT) amounts per provider for the first half of SFY 2025  (.xlsx) is available. (Updated 01/16/2025)

If you have any questions, email the HHSC PFD Hospitals Department at PFD_Hospitals@hhsc.state.tx.us.

ATLIS SFY 2025 Program Final Data Reporting Tools

Managed care organizations (MCOs) submitted their lists of in-network hospitals using the “Aligning Technology by Linking Interoperable Systems (ATLIS) Data Reporting Tool” on Oct. 15, 2024. According to the initially published timeline for ATLIS, HHSC expected to validate and update the list of in-network hospitals and send those lists back to MCOs by Nov. 15, 2024, along with the number of encounters by each of the participating hospitals.

However, HHSC determined that additional review was needed to validate each MCO’s list of in-network participating hospitals. HHSC has obtained input from hospitals to verify network statuses as of Oct. 1, 2024, and confirmed the network statuses with MCOs.

HHSC has finalized the ATLIS Program Data Reporting Tool, which contains the final network statuses for state fiscal year (SFY) 2025. Each MCO must select their name on the In Network Hospital Survey Tool in cell C1 to auto-fill their network statuses and encounters. The network statuses are locked, and MCOs cannot modify them for the SFY 2025 program period.

UMCM 6.2.17 ATLIS Program Data Reporting Tool (.xlsx)

Note: The “Year 1 Achievement Milestone Achievement: Potential MCO incentive pool by Service Delivery Area, Hospital, and Medicaid Managed Care program percentages” in the “Milestones” tab of the Data Reporting Tool workbook were also updated. The ATLIS percentages included in UMCM 6.2.17 ATLIS Program Data Reporting Tool (.xlsx) replace the percentages previously provided in the “Milestones” tab of the Uniform Managed Care Manual, Chapter 6.2.17. As a result, some MCOs will be eligible to earn funding related to certain hospital class data collection in service delivery areas (SDAs) that were not previously eligible for funding; please check these updates carefully to ensure the MCO reports for all eligible SDAs.

The deadline for MCOs to submit the first Qualitative Assessment has been extended to Feb. 3, 2025. MCOs must use the updated ATLIS Data Reporting Tool to complete the submission to HHSC.

Providers and MCOs are encouraged to contact HHSC with any questions about this update, which should be addressed to Provider Finance Hospitals.

ATLIS Network Verification FY2025

HHSC requests your assistance in obtaining input from hospitals to verify their network status with various Medicaid managed care organizations (MCOs) as of October 1, 2024, for the fiscal year (FY) 2025 ATLIS program. The file below shows the reported network status (either in or out of network) provided by Medicaid Managed Care Organizations and the network status that HHSC assumes based on claims from state fiscal year 2023.

ATLIS Network Status Validation (.xlsx)

To ensure that the lists reflect the network status as understood by the hospitals, we request that all hospitals populate column K: Provider Reported Network Status with the network statuses for each MCO/program combination. Please return the workbooks to PFD_Hospitals@hhsc.state.tx.us by 5 p.m. on Wednesday, November 27, 2024. HHSC will then combine the responses and send them to the MCOs to review all network statuses and confirm which network status is correct before they are locked.

In anticipation of questions you may have, we want to ensure that the following criteria are used when completing this tool:

  • The network status should be as of October 1, 2024.
  • The network status is based upon a network agreement between the MCO and the hospital for the particular managed care line of business (e.g. STAR, STAR Plus, STAR Kids).
  • The network status should be completed without regard for any agreements an MCO may or may not have entered into with a hospital (or a representative of the hospital) related to quality incentive payments.

The MCO ATLIS reporting tool is developed only to calculate the statistical sample and achievement basis for the service delivery areas selected by the MCO on the statistical sample collection tab. Therefore, the network status validation should not be limited by the statistical sample; the appropriate selection should be made for each hospital.

Expected Timeline

  • November 19–27: Hospitals report network status.
  • December 2–12: MCOs confirm network status.
  • December 13: HHSC returns the locked template to MCOs for data collection from hospitals.
  • January 15: ATLIS Tools due back from MCOs to HHSC.

If you have any questions, email the HHSC Provider Finance Hospitals Department at PFD_Hospitals@hhsc.state.tx.us.

Rider 150: Semi-Annual COVID-19 Reporting for Nursing Facilities and Hospitals (updated 2/27/2025)

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:

  1. Due Mar. 1, 2024: data for Sep. 1, 2023 – Jan. 31, 2024
  2. Due Sep. 1, 2024: data for Feb. 1, 2024 – Jul. 31, 2024
  3. Due Apr. 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.

  1. 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.
  2. 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

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 federal and local funds through 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 to ensure 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.

HHSC provides detailed information about the impacts on each supplemental and directed payment program. (.pdf)

If you have any questions, please email pfd_payments@hhs.texas.gov. 

Section 1115 Waiver Protocol Approved by CMS

HHSC has released the final revised Texas Uncompensated Care (UC) payment protocol which was submitted and approved by the Centers for Medicare and Medicaid Services (CMS) on July 26, 2018. Many stakeholders provided valuable feedback to HHSC on the preliminary working draft of the protocol, which was released on February 23, 2018.

CMS requires Texas to submit a revised protocol under Special Terms and Conditions (STC) for Section 1115 Demonstration Waiver renewal. The STCs require an uncompensated care protocol that only allows for charity costs under a provider’s charity policy (that adheres 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 unsuitable for any other purpose.  Further, CMS has not yet approved these workbooks, they are subject to change.  HHSC has posted the protocol and the draft Excel workbooks on the PFD UC Payments Protocol website.

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.

 Standard Dollar Amount (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