Hospital Augmented Reimbursement Program


The Hospital Augmented Reimbursement Program (HARP) is a statewide supplemental program providing Medicaid payments to hospitals for inpatient and outpatient services that serve Texas Medicaid fee-for-service (FFS) patients. The program serves as a financial transition for providers historically participating in the Delivery System Reform Incentive Payment program. HARP will provide additional funding to hospitals to assist in offsetting the cost hospitals incur while providing Medicaid services. Subject to CMS approval, eligible participants in Federal Fiscal Year 2022 include non-state government-owned and -operated hospitals and private hospitals. The public HARP SPA was approved for non-state government-owned and -operated hospitals on August 31, 2022. 


SFY 2023: The Texas Health and Human Services Commission (HHSC) announces enrollment for the Hospital Augmented Reimbursement Program (HARP). The application period runs from November 7, 2022, through December 1, 2022 5:00 PM CST. A link to the application can be found here.


HHSC has adopted new §355.8070 concerning Hospital Augmented Reimbursement Program for the program period on or after September 1, 2021. The HARP rule was published in the September 24, 2021 issue of the Texas Register and became effective September 29, 2021.

The HARP rule is available here: §355.8070.


HHSC is providing the HARP modeling for example purposes only; these are not the final program values. The program values are subject to changes based on actual enrollment, data changes, and approval issued by the Centers for Medicare and Medicaid Services (CMS). The HARP modeling is updated to reflect the final rules which can be found in the Texas Register. PDF version of the file here (.pdf). View Excel version of the file here (.xslx). The summary visualizations of the modeling are available here (.pdf)

Updated Public HARP modeling as of 09/02/2022 is available as of September 2, 2022. View the PDF version of the file here (.pdf). View Excel version of the file here (.xslx)). 

State Plan Submission

Implementation of HARP requires submission and approval of a state plan amendment (SPA). HHSC submitted two HARP SPAs, one for public providers and one for private providers, to the Centers for Medicare and Medicaid Services (CMS) on September 14, 2021. SPAs are either approved by CMS within the 90 day period or are considered automatically approved after 90 days if no questions are received from CMS. HHSC received the following questions in a formal Request for Additional Information (RAI) from CMS on each of the submitted HARP SPAs on the 90th day (December 13, 2021). These RAIs stop the clock on the SPA submission/approval and require HHSC to work with CMS to resolve their questions before the program can move forward and either SPA be approved. Please see links below for the RAIs received from CMS on December 13, 2021.

HHSC received approval of the Public HARP SPA, 21-00035, on August 31, 2022. View the approved SPA here

Suggested IGT

FFY 2022

Due to the timeline, there will be one total payment issued for the first year, which began October 1, 2021, rather than two separate payments as originally planned. Suggested Intergovernmental Transfer (IGT) amounts per provider is available here (.xlsx). (Updated 09/02/2022) Payment are anticipated to be made by the end of September 2022.