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Rate Tables


The Health and Human Services Commission (HHSC) Provider Finance Department (PFD) is responsible for setting Medicaid reimbursement rates and non-Medicaid reimbursement rates for other state programs. Based on these rates and reimbursements, PFD is publishing the provider reimbursement rate tables as a transparent resource about reimbursement levels for various Medicaid and non-Medicaid services reimbursed by the state. The rate tables contain overall percent rate changes required to recognize increases or decreases in provider costs based on various established rate methodologies. The estimated fiscal impact of a one percent rate change can be used to estimate most of the fiscal impact on the state for provider reimbursement.

HHSC PFD follows a biennial fee review schedule to systemically review Medicaid and other client services reimbursement rates. Topics are reviewed, and proposed updates are published for public comment, either during a rate hearing or in writing, in the proposed rate packets section on the PFD website located on the Rate Packets page here.

Relationship between FFS Rates and Managed Care Capitation Rates

Fee-for-Service (FFS) rates are paid to providers contracted directly with HHSC for each Medicaid and non-Medicaid service from claims submitted to the state. FFS rates are also important in the managed care delivery system for several reasons. FFS rate changes are often incorporated into the calculation of managed care capitation rates. Managed care capitation rates are paid to a managed care organization (MCO) per member per month with the expectation that the MCO will manage payments for services to providers on behalf of their enrolled clients through contractual arrangements with providers. HHSC establishes managed care capitation rates using a mathematical analysis that evaluates past experience, risk, and FFS rate modifications.

In addition, FFS rates are used as a reference tool in certain ways. Many contracts between MCOs and providers incorporate payment rates based on a percentage of the same service’s FFS rate. HHSC requires MCOs to pay rates to Medicaid providers that follow the reimbursement principles “consistent with efficiency, economy, and quality of care” and are “sufficient to enlist enough providers so that services…are available to beneficiaries at least to the extent that those services are available to the general population.” HHSC does not require MCOs to utilize the FFS rates, and some MCOs use proprietary reimbursement structures and alternate reimbursement models. These arrangements are negotiated contracts between the MCO and the Medicaid provider to which HHSC is not a party.

In addition, under Texas Government Code Section 533.00251(c)(1), HHSC is responsible for setting the minimum reimbursement rate paid to a nursing facility (NF) in the managed care program. HHSC also produces FFS equivalent rates for former FFS services that have been wholly carved into managed care to facilitate MCO capitation development.

Although these rate tables includes both FFS and Managed Care, an FFS methodology was used to calculate the impacts and does not necessarily reflect the state’s total costs associated with paying these services through the state capitation rate. These costs do include a gross-up factor for managed care premium tax costs (1.75 percent of managed care premium impact), risk margin costs (currently 1.75 percent of managed care premium impact), and administrative costs (5.25 percent, calculated from the MCO portion of expenditures).

STAR+PLUS state plan services, STAR+PLUS Home and Community-Based Services, STAR Health, STAR Kids, and STAR Kids Medically Dependent Children's Program are paid through a managed care model using a state capitation rate. The STAR+PLUS costs do not include costs associated with dual demonstration.

Additional Information for Acute Care and Hospital Rate Tables

HHSC PFD’s acute care and hospital teams develop payment rates/fees in accordance with published rules and policy guidelines. Methodologies for reimbursement rates are defined in Chapter 355 of the Texas Administrative Code rules here: Texas Administrative Code.

More information on acute care rate-setting methodologies and programs is available on the Acute Care PFD website here.

More information on hospital rate setting methodologies and programs is available on the Hospital and Clinic Services PFD website here.

Additional Information for LTSS Rate Table

The PFD Long-term Services and Supports (LTSS) rate table includes estimates for services for which HHSC sets a payment rate and had current utilization. Items reimbursed at cost, such as adaptive aids, minor home modifications, or dental services provided in the 1915(c) waivers or institutional settings, were not included in the fiscal estimates. Additionally, the fiscal estimates do not reflect costs or potential offsets for voluntary programs like Attendant Compensation Rate Enhancement, Nursing Facility Direct Care Staff Enhancement programs, or directed-payment programs such as the Quality Incentive Payment Program (QIPP) that provide enhanced payments for meeting certain metrics or spending requirements.

Base Data

The PFD LTSS rate table utilizes claims and financially examined cost report data applicable to the methodology cited on the rate table. Due to the significant impact of the COVID-19 public health emergency (PHE), programs experienced significant declines in utilization. This decline may have been the result of shutdowns or deferral of services beginning in March 2020. As a result, LTSS determined that the data after February 2020 is not necessarily indicative of future cost patterns. LTSS utilized a base period of March 2019 through February 2020 and cost report data from 2018 and 2019, for data not impacted by the PHE. This base data period aligns with data used by HHSC Actuarial Analysis to calculate the Medicaid capitation rates.

The data utilized was trended to state fiscal year 2024-25 from the applicable base period. A Personal Consumption Expenditures (PCE) price index (approximately 19 percent for 2018 to 2024-25) was utilized from the base period for costs assumed in the fully funded rates. These costs may change as new inflation factors become available.

LTSS Methodology Reviews

In addition to the biennial fee review schedule mentioned in the overview section, HHSC PFD LTSS staff are conducting reviews of certain rate methodologies. Below is a list of reviews that have recently concluded, or are currently being conducted, as of October 2022.

HCS/TxHmL and ICF/IID Reimbursement Methodology

Following General Appropriation Act (87th Legislature, Regular Session, Article II [Health and Human Services Commission] Rider 30), HHSC contracted with a third-party vendor to “evaluate the rate setting methodology” for the Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), Home and Community-based Services (HCS), and the Texas Home Living (TxHmL) programs, “including collection of any necessary data, in order to develop reimbursement methodologies that more accurately reflect the costs of services and report back to the Eighty-eighth Legislature.” HHSC will publish a report in January 2023 evaluating the current methodology. The HCS/TxHmL and ICF/IID rate table information is based on the current methodology as defined in Title 1 of the Texas Administrative Code (1 TAC) Section 355.723.

HCS SL/RSS Temporary Add-on Rates

Effective January 1, 2020 through August 31, 2023, HHSC is paying an add-on to the direct care portion of the Supervised Living and Residential Support Services (SL/RSS) rates. The add-on funds to the direct care portion of the rates are specifically for attendant compensation. The fiscal estimates assume the temporary add-on rates continue as part of the SL/RSS service costs.

Individualized Skills and Socialization Services

HHSC will replace day habilitation with a new, more integrated service called individualized skills and socialization services by March 2023. HHSC is making this change to comply with 42 Code of Federal Regulations Section 441.301(c)(4), regarding requirements for settings where Medicaid Home and Community-Based Services (HCBS) are provided. The new service will be available in the Deaf Blind Multiple Disabilities (DBMD), HCS, and TxHmL waiver programs.

In response to feedback received as part of the October 11, 2022 rate hearing, HHSC adopted the individualized skills and socialization services methodological rates with an effective date of January 1, 2023. Given the current implementation of this new service and the recent rate adoption, LTSS did not include information regarding the current day habilitation rates or the individualized skills and socialization services in the rate tables. The individualized skills and socialization services will be incorporated into future iterations of the rate tables.

Nursing Facility

The information provided in the Rate Tables for NFs reflects the percentage change based on only the Medicaid daily rate reimbursement, and not other revenue sources NFs may receive. Evaluation of the Upper Payment Limit Demonstration should be considered if any rate increase is considered. This evaluation includes the consideration of the Medicaid daily rate and other revenues sources, which include but are not limited to, the following:

  • Quality Incentive Payment Program is a voluntary performance-based payment program designed to incentivize NFs to improve the quality and innovation of their services. The program is estimated at $1.1 billion annually.
  • NFs Direct Care Staff Enhancement (rate enhancement) is a voluntary program where participating providers agree to use the additional funding to compensate direct care staff. Participating providers who fail to meet the spending requirements are subject to recoupment.
  • NFs Liability Insurance Add-On, House Bill (HB) 154, 77th Texas Legislative Session, requires HHSC to ensure that the rate determination rules for NFs “provide for the rate component derived from reported liability insurance costs to be paid only to those homes that purchase liability insurance acceptable to the commission.” In compliance with HB 154, HHSC distributes the liability insurance add-on to NFs that verify acceptable liability insurance coverage. The rate add-ons are Professional and General (PL/GL) at $1.67 per day of service; Professional Only (PL Only) at $1.53 per day of service; and General Only (GL Only) at $0.14 per day of service.
  • The NF COVID-19 temporary rate add-on was effective April 1, 2020, and is estimated to conclude at the end of the federally-declared PHE. NF providers may utilize the additional funding of $19.63 per day for COVID-related expenses, including direct care staff salary and wages, personal protective equipment (PPE), and dietary needs or supplies.

Furthermore, the current rate table information is based on the NF’s current rate methodology. The NF Payment Methodology Advisory Committee (NF-PMAC) was established by 1 TAC Section 351.839. The committee:

  • Advised HHSC on the establishment and implementation of recommended improvements to the NF reimbursement methodology and other NF payment topics;
  • Studies and makes recommendations on the development of an NF reimbursement methodology that incentivizes quality care for people served in an NF and is cost-effective, streamlined, and transparent; and
  • Performs other tasks as requested by the Executive Commissioner.

The NF-PMAC recommended a new NF reimbursement methodology, which is currently being considered by the agency. An exceptional item was submitted to request funding to support system modifications to support a new methodology.

Attendant Base Wage Calculator

In addition to the rate tables, HHSC PFD is publishing the Personal Attendant Base Wage Fiscal Estimate Calculator. The minimum attendant wage is $8.11/hour. The calculator allows the user to enter a proposed hourly wage and see the estimated fiscal impact in total and by program/service.

Questions and Inquiries

For questions and inquiries, please email HHSC Provider Finance Department at:

Rate Tables

View the 2024-2025 PFD LTSS Rate Tables (.pdf) (Excel version) (.xlsx) (01/06/2023)

View the LTSS Personal Attendant Base Wage Calculator (.xlsx) (01/06/2023)

View the 2024-2025 PFD Hospitals Rate Tables (.pdf) (Excel version)  (.xlsx) (02/10/2023)

View the 2024-2025 PFD Acute Care Rate Tables (.pdf) (Excel version) (.xlsx) (02/17/2023)