Provider Finance Communications | Provider Finance Department

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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

PFD Supplemental Payments Information

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

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) and the UC model for the rule changes here (.xlsx).

The following pre-prints are PROPOSED by CMS as of 06/01/2023

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

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

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

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

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

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

The following pre-prints are APPROVED by CMS as of 08/01/2022

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)

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

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 02/16/2023

The Texas Health and Human Services Commission (HHSC) will conduct stakeholder engagement meetings on February 16, 2023, beginning at 9:00 A.M., to receive comments on Medicaid and non-Medicaid payment rates that may be addressed at the May 2023 rate hearings. The agenda can found here.

SB 809 / Rider 143 COVID-19 Reporting Healthcare Institution List (Updated 04/25/2023)

SB809/Rider 143 Submission List as of April 25, 2023

The Health and Human Services Commission (HHSC) has posted the list of healthcare institutions who must submit reports in compliance with Senate Bill 809 or Rider 143. The list shows providers who haven’t submitted a SB 809 / Rider 143 Report as well as those HHSC staff are helping complete the report. The list can be found here (.xlsx) This list was updated with completed reports received by April 25, 2023.

Note that this list is derived at a point in time and not all inclusive as providers may enroll or change at various times. Any provider that is identified as a “Health Care Institution” defined in Section 74.001 of the Civil Practice and Remedies Code is required to complete the reports. The list has been updated to align with licensing agencies. All questions related to SB 809 / Rider 143 should be emailed to HHSC_RAD_Survey@hhs.texas.gov. There may be a delay in response due to volume.

HHSC has the authority to pursue disciplinary actions for facilities that fail to report. The health and safety of those we serve is always our top priority.

The first quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published March 1, 2022 and can be found here.

The second quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published June 1, 2022 and can be found here.

The third quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published September 1, 2022 and can be found here.

The fourth quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published December 1, 2022 and can be found here.

The fifth quarterly report for SB809/Rider 143, titled “Coronavirus Disease (COVID-19) Public Health Emergency Reporting” was published March 1, 2023 and can be found here.

SB 8, from the 87th Legislature’s third special session, authorizes grants to rural hospitals, nursing homes, home health agencies, intermediate care facilities and community attendants from the Coronavirus State Fiscal Recover Fund, established under the American Rescue Plan Act. We are required to prioritize grants to grantees who are compliant with the reporting requirements identified above. Failure to submit reports required by Senate Bill 809 or Rider 143 could limit the funding a provider may receive from the grants or disqualify them completely. Providers must submit an Initial Form, which includes funding and cost data covering the period January 2020 through August 2021. If you are delinquent in submitting the Initial Form, please email us at HHSC_RAD_Survey@hhs.texas.gov. Providers must also submit this monthly form every month. The reports are due one month after the reporting period ends. (for example, the report for December 2021 data will be due Feb. 1).

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

Monthly SB 809 / Rider 143 COVID-19 Reporting (Updated 02/25/2022)

December 12, 2022 Update:

The 87th Texas Legislature directed the Health and Human Services Commission (HHSC) to report federal COVID-19 funding from specific health care institutions, and certain costs those providers have spent related to COVID-19 public health emergency. HHSC has developed a monthly report to obtain the information required by Rider 143 (.pdf) (2022-23 General Appropriations Act, Senate Bill (S.B.) 1, 87th Legislature, Regular Session, 2021 (Article II, HHSC, Rider 143) and S.B. 809 (.pdf) (87th Legislature, Regular Session, 2021).

Frequently Asked Questions (FAQ):

View the HHSC created list of “frequently asked questions ” (FAQ) (.pdf) (Updated 03/18/2022) with the answers to common questions to assist providers in completing the report.

Reporting:

Providers must submit an Initial Form, which includes funding and cost data covering the period January 2020 through August 2021. If you are delinquent in submitting the Initial Form, please contact us at HHSC PFD Survey. The ongoing monthly reports (located here) will be ongoing and will cover a single month; each monthly report will be due on the 1st of the second following month following the end of the month (for example, the report for January 2022 data will be due March 1, 2022.)

For those providers with multiple submissions, the offline form here (.xlsx) can be used. Do not change the format in any way as this might cause your information to not be submitted. Complete the questions that apply to your specific provider type and send to HHSC_RAD_Survey@hhs.texas.gov once complete.

You will receive a confirmation page once your report has been fully completed and submitted. No email confirmation will be sent.

A pdf version of the ongoing report is available here (.pdf) for review prior to submitting the reports.

If you are unable to meet the reporting deadline, please contact the Provider Finance Department at HHSC_RAD_Survey@hhs.texas.gov for assistance.

Failure to submit:

Failure to complete and/or submit the required monthly report(s) on-time will result in:

A report to the Department of State Health Services or HHSC Regulatory Services and potential adverse actions on your licensure and/or HHSC may initiate payment holds for providers who fail to submit the required monthly reports.

List of Providers Required to Complete Reports:

The following entities are required to complete the report:

Ambulatory Surgical Centers;
Assisted Living Facilities licensed under Chapter 247, Health and Safety Code;
Emergency Medical Services Providers;
Health Services Districts created under Chapter 287, Health and Safety Code;
Home and Community Support Services Agencies;
Hospice Providers;
Hospitals;
Hospital Systems;
Intermediate Care Facilities for Individuals with an Intellectual Disability or Related Conditions (ICF/IID);
Community Living Assistance and Support Services (CLASS) or Case Management Agency (CMA) Providers;
Deaf-Blind with Multiple Disabilities (DBMD) Providers;
Home and Community-Based Services (HCS) Providers;
Texas Home Living (TxHmL) Providers;
Nursing Facilities; and
End-Stage Renal Disease Facilities licensed under Section 251.011, Health and Safety Code

Please email the HHSC Provider Finance Survey for assistance at HHSC_RAD_Survey@hhs.texas.gov.

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)

The following pre-prints are UPDATED to CMS as of 10/15/2021

State Fiscal Year 2022 Multiple DPP Pre-Print (.zip)

The following pre-prints are UPDATED to CMS as of 10/13/2021

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

The following pre-prints are UPDATED to CMS as of 09/29/2021

State Fiscal Year 2022 QIPP Pre-Print (.zip)
State Fiscal Year 2022 DPP-BHS Pre-Print (.zip)
State Fiscal Year 2022 TIPPS Pre-Print (.zip)
State Fiscal Year 2022 RAPPS Pre-Print (.zip)
State Fiscal Year 2022 CHIRP Pre-Print (.zip)

The following pre-prints were UPDATED for CMS 9/15/2021

Reconciliation Visual applicable to all pre-prints (.pdf)

State Fiscal Year 2022 QIPP Pre-Print (.pdf)
State Fiscal Year 2022 DPP-BHS Pre-Print (.zip)
State Fiscal Year 2022 TIPPS Pre-Print (.zip)
State Fiscal Year 2022 RAPPS Pre-Print (.zip)
State Fiscal Year 2022 CHIRP Pre-Print (.zip)

The following pre-prints are PROPOSED to CMS as of 07/13/2021

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)