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 Texas Health and Human Services Commission (HHSC) announces enrollment for the Hospital Augmented Reimbursement Program (HARP). The application period runs from September 17, 2021, through October 1, 2021 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) (Excel version of the file here (.xslx)) and the summary visualizations of the modeling are available here (.pdf)

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.

Public HARP SPA – 21-00035 (.pdf)
Private HARP SPA – 21-0036 (.pdf)