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 (RHCs) 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.

Methodology/Rules

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

See the preamble and rule text for new TAC updates effective January 2024 (.pdf).

Pre-Print Packages

RAPPS Participants

List of SFY 2025 RAPPS Participants and SFY 2026 RAPPS Applicants (.xlsx)

SFY 2026 (Year 5)

Enrollment

Enrollment is now closed for RAPPS state fiscal year (SFY) 2024. Enrollment was open from February 3, 2025, through February 24, 2025. A PDF version of the enrollment application is available here (.pdf).

Suggested IGT

The Suggested Intergovernmental Transfer (IGT) amounts per provider are available here (.xlsx) (Updated 5/2/2025)

The modeling is available here (.pdf), and the Excel version can be located here (.xlsx) (Updated 5/2/2025)

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

SFY 2025 (Year 4)

Enrollment

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

Suggested IGT

First Half Year 4 (SFY2025) Suggested IGT Transfer

Suggested Intergovernmental Transfer (IGT) amounts per provider is available here (.xlsx) (Updated 10/5/2024)

The modeling is available here (.pdf), and the Excel can be located here (.xlsx) (Updated 10/5/2024)

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

Second Half Year 4 (SFY2025) Suggested IGT Transfer

Suggested Intergovernmental Transfer (IGT) amounts per provider is available here (.xlsx) (Updated 11/1/2024)

The modeling is available here (.pdf), and the Excel can be located here (.xlsx) (Updated 11/1/2024)

Component 1 Scorecards

Component 1 (100% of the RAPPS funding) is a uniform dollar increase paid prospectively every month. 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.

SFY 2024 (Year 3)

Enrollment 

Enrollment is now closed for RAPPS SFY 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 6/13/2023)

The modeling is available here (.pdf), and the Excel can be located here (.xlsx) (Updated 6/13/2023)

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 11/8/2023)

The modeling is available here (.pdf),  and the Excel can be located here (.xlsx)  (Updated 11/8/2023)

Component 1 Scorecards

Component 1 (75% of the RAPPS funding) is a uniform dollar increase paid prospectively every month. 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.

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) Updated Component 2 Rate Increase Percentages by NPI  (.pdf) (Updated 1/9/2024)

RAPPS Component 1 Reconciliation Scorecard SFY 2024

Per 1 TAC Section 353.1315 the interim allocation of Component 1 funds across qualifying providers will be reconciled to the actual Medicaid utilization across enrolled rural health clinic (RHC) 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.

The RAPPS SFY 2024 (Year 3) Component 1 Reconciliation Scorecard (.pdf) and Excel version of this RAPPS Scorecard (.xlsx) are available. (Updated 04/25/2025)

SFY 2023 (Year 2)

Enrollment

Enrollment is now closed for RAPPS state fiscal year (SFY) 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 6/14/2022)

The modeling is available here (.pdf), and the Excel can be located here (.xlsx) (Updated 6/14/2022)

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 11/9/2022)

The modeling is available here (.pdf), and the Excel can be located here (.xlsx)  (Updated 11/9/2022)

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 every month. 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.

 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 9/15/2022)

RAPPS Component 1 Reconciliation Scorecard SFY 2023

Per 1 TAC Section 353.1315 the interim allocation of Component 1 funds across qualifying providers will be reconciled to the actual Medicaid utilization across enrolled rural health clinic (RHC) 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.

The RAPPS SFY 2023 (Year 2) Component 1 Reconciliation Scorecard (.pdf) and the Excel version of this RAPPS Scorecard (.xlsx) files are available (Updated 3/20/2024).

SFY 2022 (Year 1)

Modeling

To assist potential applicants, HHSC drafted a model of the potential earnings of RHCs under the RAPPS program. Please note that 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 the CMS. The proposed RAPPS modeling (.pdf) and the Excel version of the modeling file (.xlsx) are available.

Enrollment

HHSC collected SFY 2022 enrollment applications for RAPPS from March 24, 2021, through April 13, 2021. The enrollment period is now closed.

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 5/27/2021)

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 every month. 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. 

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 4/27/2022)

RAPPS Component 1 Reconciliation Scorecard SFY 2022

Per 1 TAC Section 353.1315 the interim allocation of Component 1 funds across qualifying providers will be reconciled to the actual Medicaid utilization across enrolled rural health clinic (RHC) 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 the conditions of participation are displayed with a recoupment of all program funds paid.

The RAPPS SFY 2022 (Year 1) Component 1 Reconciliation Scorecard (.pdf) and the Excel version of the 2022 Scorecard (.xlsx) (Updated 4/12/2023) are available.