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Provider Finance Communications

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Overview

The information included on this webpage includes communications sent out by HHSC Provider Finance, meeting materials, GovDelivery archives and other reference information. Any questions should be directed to ProviderFinanceDept@hhs.texas.gov.

Announcements

Effective on March 1, 2024, meetings with external stakeholders and the Provider Finance Department will be, by default, in-person to improve the likelihood that the meeting will be productive, focused, and professional. Exceptions to the in-person meeting policy may be requested to accommodate virtual participation for providers or Medicaid beneficiaries who are not located in the Austin area and will be permitted on a case-by-case basis. However, in such instances, if a stakeholder has representatives, consultants, or agents that are located in the Austin area, HHSC will ask those meeting participants to join in-person.  

Virtual participation options will be made available for ad-hoc, urgent, or one-directional communications, or in instances where virtual participation is deemed necessary to promote public comment and input. 

Because staff are present in the office only on certain weekdays, meetings will generally be scheduled on the weekday that the largest number of participating staff are scheduled to be in the office. 

Texas Rural Emergency Hospitals Financial Stabilization Open Enrollment Grant

The Health and Human Services Commission (HHSC) is an agency within the Health and Human Services (HHS) system. HHSC is seeking Applications to establish Contract(s) with qualified rural hospitals to support access to client care by reimbursing rural hospital operational expenses to promote financial stabilization of rural hospital(s) that have received a Rural Emergency Hospital designation from the Centers for Medicare and Medicaid Services by August 31, 2023. The Grant Payments will be paid through the Rural Hospital Grant (“Grant”). To be considered for award, Applicants must submit a comprehensive Application which meets all the requirements of this OE and includes all requested documentation.

For further information or to apply for this grant – please click here, HHS0014031 | Offices and Services (texas.gov) 

Rider 150: Semi-Annual COVID-19 Reporting for Nursing Facilities and Hospitals (updated 2/21/2024)

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 – Aug. 31, 2024 
  3. Due Mar. 1, 2025: data for Sep. 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.

PFD Payments Calendar

The PFD Payments Calendar, Intergovernmental Transfer (IGT) Set Up Instructions, and related resources are available here on the new PFD Supplemental Payments Information page.

Enhanced Ambulatory Patient Groups (EAPGs)

DRAFT Outpatient Prospective Payment System (OPPS) Modeling using Enhanced Ambulatory Patient Groups (EAPGs) Now Available

Note: All EAPG analysis is subject to change upon data refresh.

HHSC has developed the draft modeling files below to demonstrate anticipated payments as a result of future implementation of the OPPS modeling based on EAPGs.

EAPG Impact Analysis (.xlsx) (Updated 09/22/2023)

EAPG Provider Payment Gain and Loss Analysis (.pdf) (Updated 09/22/2023)

EAPG Methodology (.pdf) (Updated 09/28/2023)

Provider Rates 3M Weights EAPG Type Analysis (.xlsx) (Updated 09/28/2023)

Impact by MCO FFS Analysis (.xlsx) (Updated 09/28/2023)

3M offers the following site URL and registration information for users to access the EAPG definition manual:
https://patientclassificationmethodologies.3mhis.com/login

Registration Instructions - EXTERNAL USERS (.pdf)

HHSC is planning to implement the outpatient prospective payment system (OPPS) reimbursement in conjunction with the implementation of a modernized Medicaid Information System (MMIS), on December 1, 2024. The OPPS transition is required by Texas Government Code §536.005 (enacted in the 82nd Texas Legislature, 1st Called Session, 2011), which requires that HHSC "convert outpatient hospital reimbursement systems to an appropriate prospective payment system." In addition, the 2014-15 General Appropriations Act, Senate Bill 1, 83rd Legislature, Regular Session, 2013 (Article II, HHSC, Rider 38) stated that "in order to ensure that access to emergency and outpatient services remain in rural parts of Texas, it is the intent of the Legislature that when HHSC changes its outpatient reimbursement methodology to a 3MTM Enhanced Ambulatory Patient Groups [EAPG] or similar methodology, HHSC shall promulgate a separate or modified payment level for the above defined providers."

Please direct questions related to the draft modeling to: pfd_opps@hhs.texas.gov

Preprint Technical Correction is APPROVED by CMS as of 9/20/2023

CMS approved technical corrections for CHIRP SFY2024. Linked below is the Approval Package.

CHIRP Technical Correction Approval 09/20/2023 (.pdf)

CHIRP technical correction submitted for SFY2024

Provider Finance has submitted a Pre-Print technical correction related to the FY2024 Comprehensive Hospital Increase Reimbursement Program (CHIRP).

Linked below are the corrected files for the program.

Cover Letter - CHIRP Technical Correction for FY24 (.pdf) 

SFY 2024 CHIRP Preprint 08.25.2023 (.zip)

The following State Plan Amendments are APPROVED by CMS as of 08/15/2023

CMS approved the State Plan Amendments for Private GME and Private HARP on August 15, 2023.Linked below are the approval packages from CMS and the funding estimates for each program.
 
TX-19-0020 Approved (Private GME SPA) (.pdf)

TX-21-0036 DRR Approved (Private HARP SPA) (.pdf)

2020 Private GME Estimate (.xlsx)

2022 Private HARP Estimate (.xlsx) 

The following pre-prints are APPROVED by CMS as of 07/31/2023

State Fiscal Year 2024 CHIRP Pre-Print Package (.zip)

State Fiscal Year 2024 DPP BHS Pre-Print Package (.zip)

State Fiscal Year 2024 QIPP Pre-Print Package (.zip)

State Fiscal Year 2024 RAPPS Pre-Print Package (.zip)

State Fiscal Year 2024 TIPPS Pre-Print Package (.zip)

Amendments to Rules related to Disproportionate Share Hospital and Uncompensated Care Programs Reimbursement

The Texas Health and Human Services Commission (HHSC) will be adopting amendments to §355.8065, concerning Disproportionate Share Hospital Reimbursement Methodology, §355.8066, concerning Hospital-Specific Limit Methodology, and §355.8212, concerning Waiver Payments to Hospitals for Uncompensated Charity Care.

Sections 355.8065, 355.8066, and 355.8212 will be adopted with changes to the proposed text as published in the April 14, 2023, issue of the Texas Register (48 TexReg 1903) (https://www.sos.state.tx.us/texreg/). These rules will be republished in the June 16, 2023 issue of the Texas Register. You can view a copy of the submitted adoption filing here  (.pdf). 

You can view the DSH model for the rule changes here  (.xlsx) (Updated 07/06/2023), and the UC model for the rule changes here  (.xlsx). (Updated 07/06/2023)

NF-CHRG Tier 1 Direct Award: Awarded Funds Utilization Report

Awarded Funds Utilization Report Required for All NFs That Received Direct Awards

The Texas Health and Human Services Commission (HHSC) completed disbursement of the Noncompetitive Direct Awards for Nursing Facilities in the Healthcare Relief Grant (NF-CHRG) program as directed by Senate Bill 8, 87th Legislature, 3rd Called Session, 2021.

Each Nursing Facility (“NF” or “Beneficiary”) that received noncompetitive direct award funds ($75,000 per NF) under the Nursing Facility COVID-19 in Healthcare Relief Grant (View NF-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 NF that received the $75,000 award. If a legal entity owns multiple NFs that received an award under Tier 1, then that legal entity must submit multiple Reports: one Report for each NF facility ID number.

Click HERE (.xlsx) for a list of received reports. This data is current as of the date written in the title of the document.

Recoupments:

In accordance with Section IV of Attachment A: Statement of Work, HHSC may recoup up to the full amount of $75,000 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 NF that received a $75,000 NF-CHRG Noncompetitive Direct Award.
  • Each NF's Facility ID 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 NF-CHRG Tier 2 (RFA #HHS0011337).
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

Public Hearing on Proposed Amendments to Rule -- Reimbursement Methodology for School Health and Related Services (SHARS)

The Health and Human Services Commission (HHSC) is accepting comments on the proposed new Title 1, Texas Administrative Code (TAC) §355.8443, concerning the Reimbursement Methodology for School Health and Related Services (SHARS). The proposed amendment was published in the April 29, 2022, issue of the Texas Register (.pdf).

HHSC is accepting public comments on the proposed amendment until May 30, 2022. A public hearing to receive comments on the proposal is scheduled for May 18, 2022, at 1:00pm (CDST). Due to the declared state of disaster stemming from COVID-19, this hearing will be conducted online only. Persons interested in attending may register for the public hearing register for the public hearing here. You may also submit written comments via email.

The following pre-prints are PROPOSED to CMS as of 03/01/2022

State Fiscal Year 2023 QIPP Pre-Print (.zip)
State Fiscal Year 2023 DPP-BHS Pre-Print (.zip)
State Fiscal Year 2023 TIPPS Pre-Print (.zip)
State Fiscal Year 2023 RAPPS Pre-Print (.zip)
State Fiscal Year 2023 CHIRP Pre-Print (.zip)

HHSC Public Rule Hearing for Rural Health Clinics 

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on January 24, 2022, at 2:00 p.m., to receive public comments on the proposed rule for the Medicaid Reimbursement for Rural Health Clinics (RHC). The notice can found here.

HHSC Provider Finance Stakeholder Engagement Meeting on 09/14/2023

The Texas Health and Human Services Commission (HHSC) will conduct stakeholder engagement meetings on September 14, 2023, beginning at 9:00 A.M., to receive comments on Medicaid and non-Medicaid payment rates that may be addressed at the November 2023 rate hearings. The agenda can found here.

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

Initial Uncompensated Care Pool Resizing Submission (STC 41)

Texas Notes and Changes to the UC Limit Calculation Model Template (.pdf)
Letter from Provider HHSC Finance Department to CMS (.pdf)
DY12 UC Sizing Template- CMS (.pdf)

State Fiscal Year 2022 QIPP Pre-Print (.zip)

Reporting Requirements and Auditing

All recipients of Provider Relief Fund (PRF) payments must comply with the reporting requirements described in the Terms and Conditions and specified in directions issued by the Secretary.

Update: The PRF Reporting Portal is now open for recipients who are required to report during Reporting Period 1. PRF recipients may use payments for eligible expenses and lost revenues to prevent, prepare for, and respond to coronavirus.

HRSA will host recorded Reporting Technical Assistance Sessions to provide technical assistance on reporting requirements for PRF recipients and stakeholders:

July 14, 2021 at 3 PM ET (Register here) July 20, 2020 at 3 PM ET (Register here)

Ambulance Provider Average Commercial Rate (ACR) Application

Enrollment for the Enhanced supplemental payment program will begin on April 14, 2021. The application is available here. A PDF version of the application is available here (.pdf). The Reimbursement Methodology for Ambulance Services rule is available here (.pdf).

HHSC Publishes IGT Deadlines for Directed Payment Programs

HHSC is providing the first intergovernmental transfer (IGT) due dates and other related deadlines for the state fiscal year 2022 directed payment programs here (.pdf). The IGT due dates published are for the first half of IGT only. HHSC will publish the IGT due dates for the second half of IGT in the upcoming future.

Effective September 1, 2021, HHSC will operate five directed payment programs: 

• Comprehensive Hospital Increase Reimbursement Program (CHIRP)
• Texas Incentives for Physician and Professional Services (TIPPS)
• Quality Incentive Payment Program (QIPP)
• Rural Access to Primary and Preventive Services (RAPPS)
• Directed Payment Program for Behavioral Health Services (DPP for BHS)

Additional information about the directed payment programs is available on the HHSC web site.

HHSC Models Estimated Hospital Program Payments for Federal Fiscal Year 2021 and 2022

HHSC has received many inquiries asking about the total impact of the modeled CHIRP and FFS payments on the DSH and UC payments.  While the models for both program are illustrative only and actual payments would be subject to actual enrollment, approval by CMS, and other decisions that have not yet been made, HHSC has modeled the impact on DSH and UC payments if payments are made as modeled. HHSC has modeled the DSH and UC payments two ways – first with only CHIRP included in the state payment cap or hospital specific limits and second with both CHIRP and the FFS supplemental payment program payments included in the state payment cap or hospital specific limit calculations.  At the beginning of the visualizations, there are a few graphics showing the change in DSH and UC payments from the inclusion of the FFS payments in the state payment cap or hospital specific limit. The remaining visualizations focus on modeling total program payments with the inclusion of the FFS payments in the state payment cap or hospital specific limit.  HHSC has not yet decided whether the proposed FFS supplemental payment program will include a quality incentive arrangement, which may influence whether the payment must be applied to the SPC or HSL.  HHSC looks forward to finalizing the proposal for the FFS supplemental payment program that was announced last week and continuing to work with all providers to explore financial solutions that support Texans access to high quality care. A copy of the model can be found here (.pdf) and here (.xslx), and the summary of the visualizations are posted here (.pdf).

Notice of Public Hearing on Proposed Rule for the Public Health Provider – Charity Care Program

The Texas Health and Human Services Commission (HHSC) will conduct a public hearing on March 26, 2021, at 11:30 a.m. CDT, to receive public comments on the proposed rule for the Public Health Provider – Charity Care Program (PHP-CCP). Persons interested in attending may register for the public hearing here. Please click here (.pdf) for more information.

Monitoring Plan for Local Funds Used to Support Medicaid Payments

To increase oversight of local funds used as the non-federal share, the Health and Human Services Commission (HHSC) is proposing to implement a process to monitor the financing structures that underlie the local funding. This effort is part of HHSC’s initiative in the Blueprint for a Healthy Texas to improve accountability and sustainability of supplemental and directed payment programs to achieve positive outcomes. 

The Draft Monitoring Plan for Local Funds Used to Support Medicaid Payments (.pdf) is published for public comment on October 22, 2020. Comments will be accepted until 5 p.m. on November 12, 2020 and can be sent by email to RAD_1115_Waiver_Finance@hhsc.state.tx.us.

Materials from the August 14th stakeholder meeting

View the Webinar Recording (.wmv) (8-14-2020)
View the Webinar Presentation (.pdf) (8-14-2020)
View the Webinar Frequently Asked Questions (.pdf) (8-14-2020)