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Rural Access to Primary and Preventive Services

Overview

The Rural Access to Primary and Preventive Services (RAPPS) is a directed payment program that incentivizes primary and preventive services for persons with Medicaid in rural areas of the state enrolled in STAR, STAR+PLUS, and STAR Kids. The program focuses on the management of chronic conditions. Two types of rural health clinics (RHC) are eligible to participate: (1) hospital-based RHCs, which include non-state government-owned and private RHCs, and (2) freestanding RHCs. Eligible RHCs must provide at least 30 Medicaid managed care encounters per year.

Texas Response to CMS Round 1 Questions for SFY 2023 RAPPS (April 21, 2022) (.pdf)
Texas Response to CMS Round 2 Questions for SFY 2023 RAPPS (May 16, 2022) (.pdf)
Texas Response to CMS Round 3 Questions for SFY 2023 RAPPS (June 8, 2022) (.pdf)
Texas Response to CMS Round 4 Questions for SFY 2023 RAPPS (July 8, 2022) (.pdf) 
CMS RAPPS Approval Letter (March 25, 2022) (.pdf)
CMS Renewal Approval Letter for SFY 2023 RAPPS (August 1, 2022) (.pdf)

Methodology/Rules

RAPPS program rules were published in the April 23, 2021 issue of the Texas Register and became effective April 25, 2021. The rules are 1 Texas Administrative Code §353.1315, concerning Rural Access to Primary and Preventive Services Program; and 1 Texas Administrative Code §353.1317, concerning Quality Metrics for Rural Access to Primary and Preventive Services Program. 

New TAC updates effective January 2024: see preamble and rule text here (.pdf).

Pre-Print Packages

View Proposed SFY 2022 RAPPS Pre-Print Package of 07/13/2021 (.zip)
View Updated SFY 2022 RAPPS Pre-Print Package as of 09/15/2021 (.zip)
View Updated SFY 2022 RAPPS Pre-Print Package as of 09/29/2021 (.zip)
View Approved SFY 2022 RAPPS Pre-Print Package as of 04/21/2022 (.zip)(Posted 05/20/2022)
View Proposed SFY 2023 RAPPS Pre-Print Package as of 03/01/2022 (.zip)
View Approved SFY 2023 RAPPS Pre-Print Package as of 08/01/2022 (.zip)
View Proposed SFY 2024 RAPPS Pre-Print Package as of 06/01/2023 (.zip)
View Approved SFY 2024 RAPPS Pre-print Package

SFY2025 (Year 4)

Enrollment

The Texas Health and Human Services Commission (HHSC) announces enrollment for the Rural Access to Primary and Preventative Services (RAPPS) program from February 1, 2024, through February 21, 2024. The application (view here) should take about 10-15 minutes to complete and is for the eligibility period from September 1, 2024 to August 31, 2025. A PDF version of the application is available here (.pdf).

SFY2024 (Year 3)

Enrollment 

Enrollment is now closed for RAPPS state fiscal year 2024. Enrollment was open from February 1, 2023, through February 21, 2023. A PDF version of the application is available here (.pdf)

Suggested IGT

First Half Year 3 (SFY2024) Suggested IGT Transfer

Suggested Intergovernmental Transfer (IGT) amounts per provider is available here (.xlsx) (Updated 06/13/2023)

The modeling is available here (.pdf), and the excel can be located here (.xlsx) (Updated 06/13/2023)

IGT Commitment form is available here (.pdf), and the excel version can be located here (.xlsx).

Second Half Year 3 (SFY2024) Suggested IGT Transfer

Suggested Intergovernmental Transfer (IGT) amounts per provider is available here (.xlsx) (Updated 11/08/2023)

The modeling is available here (.pdf),  and the excel can be located here (.xlsx)  (Updated 11/08/2023)

Component 1 Scorecards

Component 1 (75% of the RAPPS funding) is a uniform dollar increase paid prospectively on a monthly basis. Freestanding and hospital-based RHCs are eligible to participate in Component 1. Managed Care Organizations (MCOs) must make HHSC-calculated payments to a RAPPS participant in accordance with the scorecard. 

View RAPPS SFY 2024 (Year 3) September Scorecard Final  (.xlsx) (Updated 9/15/2023)

View RAPPS SFY 2024 (Year 3) October Scorecard Final  (.xlsx) (Updated October 16, 2023)

View RAPPS SFY 2024 (Year 3) November Scorecard Final (.xlsx) (Updated November 15, 2023)

View RAPPS SFY 2024 (Year 3) December Scorecard Final (.xlsx) (Updated December 15, 2023)

View RAPPS SFY 2024 (Year 3) January Scorecard Final (.xlsx) (Updated January 15, 2024)

View RAPPS SFY 2024 (Year 3) February Scorecard Final (.xlsx) (Updated February 15, 2024)

Component 2 Rate Increase Percentage

Component 2 (25% of the RAPPS funding) is a percentage increase on all applicable services. Freestanding and hospital-based RHCs are eligible to participate in Component 2. MCOs must provide a monthly percentage increase and a uniform percentage rate increase for all or a subset of services performed in the MCO network as outlined in 1 Texas Administrative Code §353.1315. 

View RAPPS SFY 2024 (Year 3) Component 2 Rate Increase Percentages by NPI  (.pdf)  (Updated 09/15/2023)

 

SFY2023 (Year 2)

Enrollment

Enrollment is now closed for RAPPS state fiscal year 2023. Enrollment was open from March 2, 2022, through March 29, 2022. A PDF version of the application is available here (.pdf).

Suggested IGT

First Half Year 2 (SFY2023) Suggested IGT Transfer

Suggested Intergovernmental Transfer (IGT) amounts per provider is available here (.pdf), an excel version of the file can be located here (.xlsx). (Updated 06/14/2022)

The modeling is available here (.pdf), and the excel can be located here (.xlsx) (Updated 06/14/2022)

Second Half Year 2 (SFY2023) Suggested IGT Transfer

Suggested Intergovernmental Transfer (IGT) Amounts per provider is available here (.pdf), an excel version of the file can be located here (.xlsx). (Updated 11/09/2022)

The modeling is available here (.pdf), and the excel can be located here (.xlsx)  (Updated 11/09/2022)

The IGT Declaration of Intent form is available here (.pdf), and excel file can be located here (.xlsx).

Year 2 Additional Suggested IGT Transfer

Suggested Intergovernmental Transfer (IGT) Amounts per provider is available here (.pdf), an excel version of the file can be located here (.xlsx). (Updated 7/19/2023)

Component 1 Scorecards

Component 1 (75% of the RAPPS funding) is a uniform dollar increase paid prospectively on a monthly basis. Freestanding and hospital-based RHCs are eligible to participate in Component 1. Managed Care Organizations (MCOs) must make HHSC-calculated payments to a RAPPS participant in accordance with the scorecard.

View RAPPS SFY 2023 (Year 2) September Scorecard Final (.xlsx) (Updated 9/15/2022)

View RAPPS SFY 2023 (Year 2) October Scorecard Final (.xlsx) (Updated 10/17/2022)

View RAPPS SFY 2023 (Year 2) November Scorecard Final (.xlsx) (Updated 11/15/2022)

View RAPPS SFY 2023 (Year 2) December Scorecard Final (.xlsx) (Updated 12/15/2022)

View RAPPS SFY2023 (Year 2) January Scorecard Final (.xlsx) (Updated 01/17/2023)

View RAPPS SFY2023 (Year 2) February Scorecard Final (.xlsx) (Updated 02/15/2023)

View RAPPS SFY2023 (Year 2) March Scorecard Final (.xlsx) (Updated 03/15/2023)

View RAPPS SFY2023 (Year 2) April Scorecard Final (.xlsx) (Updated 04/17/2023)

View RAPPS SFY2023 (Year 2) May Scorecard Final (.xlsx) (Updated 05/15/2023)

View RAPPS SFY2023 (Year 2) June Scorecard Final (.xlsx) (Updated 06/15/2023)

View RAPPS SFY23 (Year 2) Scorecard July 2023 (.xlsx) (Updated 07/17/2023)

 View RAPPS SFY23 (Year 2) Scorecard August 2023.xlsx) (Updated 08/15/2023)

 Component 2 Rate Increase Percentage

Component 2 (25% of the RAPPS funding) is a percentage increase on all applicable services. Freestanding and hospital-based RHCs are eligible to participate in Component 2. MCOs must provide a monthly percentage increase and a uniform percentage rate increase for all or a subset of services performed in the MCO network as outlined in 1 Texas Administrative Code §353.1315.

View RAPPS SFY 2023 (Year 2) Component 2 Rate Increase Percentages by NPI (.pdf) (Updated 09/15/2022)

State Fiscal Year 2022 (Year 1)

State Fiscal Year 2022 (Year 1)

Modeling

To assist potential applicants, HHSC has drafted a model of the potential earnings of RHCs under the RAPPS program. Please note: the modeling is only an example and does not reflect the final program values. The program values in the model are subject to changes based on the actual enrollment, data changes, and approval issued by CMS. The proposed RAPPS modeling is available here (.pdf) (excel version of the file here (.xlsx)).

Enrollment

The Texas Health and Human Services Commission (HHSC) collected SFY2022 enrollment applications for RAPPS from March 24, 2021, through April 13, 2021. The enrollment period is now closed. 

RAPPS Component 1 Reconciliation Scorecard SFY 2022 

Per Texas Administrative Code §353.1315 the interim allocation of Component 1 funds across qualifying providers will be reconciled to the actual Medicaid utilization across enrolled rural health clinics (RHCs) providers during the program period, as captured by Medicaid Managed Care Organizations (MCOs) contracted with HHSC for managed care 120 days after the last day of the program period. Providers who did not meet conditions of participation are displayed with a recoupment of all program funds paid. 

RAPPS SFY 2022 (Year 1) Component 1 Reconciliation Scorecard is available here (.pdf), excel file can be located here (.xlsx) (Updated 04/12/2023)

Suggested IGT

Suggested Intergovernmental Transfer (IGT) amounts per provider is available here (.pdf), an excel version can be located here (.xlsx).

The modeling is available here (.pdf), and the excel can be located here (.xlsx) (Updated 05/27/2021)

The IGT Declaration of Intent form is available here (.pdf), and excel file can be located here (.xlsx).

Component 1 Scorecards

Component 1 (75% of the RAPPS funding) is a uniform dollar increase paid prospectively on a monthly basis. Freestanding and hospital-based RHCs are eligible to participate in Component 1. Managed Care Organizations (MCOs) must make HHSC-calculated payments to a RAPPS participant in accordance with the scorecard. 

View RAPPS SFY 2022 (Year 1) Sept – Apr Scorecard Final (.xlsx) (Updated 06/06/2022)

View RAPPS SFY 2022 (Year 1) May Scorecard Final (.xlsx) (Updated 06/06/2022)

View RAPPS SFY 2022 (Year 1) June Scorecard Final (.xlsx) (Updated 06/16/2022)

View RAPPS SFY 2022 (Year 1) July Scorecard Final (.xlsx) (Updated 07/15/2022)

View RAPPS SFY 2022 (Year 1) August Scorecard Final (.xlsx) (Updated 08/12/2022)

Component 2 Rate Increase Percentage

Component 2 (25% of the RAPPS funding) is a percentage increase on all applicable services. Freestanding and hospital-based RHCs are eligible to participate in Component 2. MCOs must provide a monthly percentage increase and a uniform percentage rate increase for all or a subset of services performed in the MCO network as outlined in 1 Texas Administrative Code §353.1315

View RAPPS SFY 2022 (Year 1) Component 2 Rate Increase Percentages by NPI (.xlsx) (Updated 04/27/2022)