Medicare and Medicaid

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Medicare and Medicaid

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With Medicare and Medicaid providing more than half of most hospitals’ patient revenue, any changes to these government-sponsored programs have a significant impact on hospitals. Federal health care reform will change these programs significantly over the next decade, as well as make dramatic modifications to private insurance practices. The Texas Legislature sets the Medicaid program budget for each biennium, and also oversees the regulation of the state’s insurance industry through the Texas Department of Insurance. THA works with the Texas Legislature on legislation that affects health care financing. Through involvement with specific Medicaid advisory committees, the Texas Health and Human Services Commission and the Texas Department of State Health Services, THA helps shape the regulatory environment.

Additional Information

Medicare Resources

Special Bulletin: CMS Issues Hospital Outpatient/ASC Proposed Rule, Modifications to Price Transparency Rule (7/20/21) | AHA
CY 2022 Proposed Hospital OPPS Rule (7/19/21) | CMS
THA Comments on CMS’ FY 2022 Proposed Hospital Inpatient Prospective Payment System Rule (June 28, 2021)
THA Comments on CY 21 Proposed Physician Fee Schedule Rule (Oct. 5, 2020)
THA Comments on Proposed Retractive Rulemaking on Medicare DSH Policy (Oct. 5, 2020)
THA Comments on CY 21 Proposed Hospital Outpatient PPS Rule (Oct. 5, 2020)
THA Comments on CMS’ 2021 Medicare IPPS & LTACH Proposed Rule (July 7, 2020)
THA/TORCH Medicare Advantage Letter to U.S. Rep. Lloyd Doggett (Nov. 1, 2019)
THA Comments on Proposed FFY 2020 Outpatient Prospective Payment System Rule (Sept. 27, 2019)
Beneficiary and Family Centered Care Quality Improvement Organization Transition Announcement (2019)
THA Follow-Up Comment Letter on Medicare Rural Payment Programs (May 27, 2017)
THA Comments on Direct Supervision for Therapy Services and Rural Issues (May 10, 2017)
CMS Delays Medicare Bundled Payment Rule (Feb. 17, 2017)
Medicare Fiscal Intermediary Transition
Medicare RAC Progam

Medicaid Resources

General/Directed Payment Programs

Texas Accepts Offer for FY 22 DSRIP, UHRIP, QIPP; Commits to Work on DPPs (9/7/21) | HHSC
Attachment C - State Report of Mandatory Payments & Administrative Expenditures FFY 21 Q3 (8/25/21) | HHSC
Attachment B - Oversight & Monitoring Plan for Local Funds Used in Texas Medicaid (8/25/21) | HHSC
Attachment A - CHIRP Analysis (8/25/21) | HHSC
Discussion Document With State Responses Re: Requested DPP Modifications (8/25/21) | HHSC
Discussion Document Re: Requested DPP Modifications (8/20/21) | CMS
Response to CMS Regarding DPPs (8/16/21) | HHSC
Letter Disapproving Proposed Directed Payment Programs (8/13/21) | CMS
Comments on Proposed Hospital Augmented Reimbursement Program Rules (8/6/21) | THA
Proposed Rural Hospital Medicaid Inpatient Rate Increase (7/8/21) | HHSC
Proposed Rural Hospital Medicaid Outpatient Rate Increase (7/8/21) | HHSC
Preliminary Modeling by Hospital - Hospital Augmented Reimbursement Program (5/19/21) | HHSC
Summary of Preliminary Modeling for Hospital Augmented Reimbursement Program (5/19/21) | HHSC
Healthy Texas Women Eligibility Changes Q&A (April 28, 2021) | HHSC
SFY 2022 Quality Measure Specifications for CHIRP, TIPPS, RAPPS, BHS (March 18, 2021)
Legislative Report: Opportunities to Advance VBP in Texas (Nov. 17, 2020) | HHSC
THA, TEHP Comment on HHSC Local Funds Monitoring Plan (Nov. 12, 2020)
Editorial: Now Is the Time to Broaden Health Care Coverage (Oct. 16, 2020) | THA
THA, Provider Groups Urge Protection of HHSC Eligibility, Enrollment Staff (Oct. 6, 2020)
Joint-Association Request to Protect Hospital Rates in Budget Cuts (June 10, 2020)
HHSC Announces Changes for Medicaid Supplemental Payment Programs (Sept. 17, 2019)

Comprehensive Hospital Increased Reimbursement Program

Updated CHIRP Modeling (PDF) (March 4, 2021) | HHSC
Updated CHIRP Modeling (Excel) (March 4, 2021) | HHSC
Summary Visualizations of CHIRP Modeling (March 4, 2021) | HHSC
Final CHIRP Rules (March 4, 2021) | HHSC
Final CHIRP Rules Adoption Preamble (March 4, 2021) | HHSC
Comments to HHSC on Proposed CHIRP Quality Measures (Feb. 2, 2021) | THA
Comments to HHSC on Proposed CHIRP Rule (Feb. 1, 2021) | THA
CHIRP Proposed Measures Survey (Jan 12, 2021) | HHSC
CHIRP Directed Payment Program Specifications (Jan. 12, 2021) | HHSC
CHIRP Requirements (Jan. 12, 2021) | HHSC
HHSC Proposed Rules for CHIRP (§353.1305 – 353.1307) (Jan. 1, 2021)

Legacy Uniform Hospital Rate Increase Program

Hospital Groups Comment on UHRIP Reform Efforts (Sept. 28, 2020)
Revised Proposal for FY 2021 UHRIP Payments (June 18, 2020)
HHSC/CMS Request for Commercial Payment Data for SFY 21 UHRIP Review (June 4, 2020)
Top 10 Inpatient, Outpatient Diagnosis Codes by Provider Type (June 4, 2020)
HHSC Update: FY 2021 Proposed UHRIP Reforms on Hold (Feb. 5, 2020)
HHSC Update on UHRIP Changes for SFY 2020 (Feb. 3, 2020)
HHSC Proposed Changes for UHRIP Reform (Sept. 17, 2019)
THA Comments on HHSC’s UHRIP Rules (Sept. 24, 2017)
UHRIP Issues and HHSC Responses (July 10, 2017)
THA Comments on HHSC Proposed Uniform Rate Hospital Increase Program (Feb. 21, 2017)

Texas Incentives for Physician and Professional Services Program

Updated TIPPS Modeling (Excel) (March 9, 2021) | HHSC
Final TIPPS Rules Adoption Preamble (March 9, 2021) | HHSC
Final TIPPS Rules (March 9, 2021) | HHSC
Comments to HHSC on Proposed TIPPS Program (Jan. 25, 2021) | THA

Rural Access to Primary and Preventive Services Program

Comments to HHSC on Rural Access to Primary and Preventive Services (Feb. 12, 2021) | THA

Disproportionate Share Hospital Payments & Uncompensated Care

Comments on Proposed DSH Reimbursement Methodology Rule (5/17/21) | THA
Proposed Medicaid DSH Reimbursement Methodology Rule (4/16/21) | HHSC
DY 9 DSH and UC Application (July 2019)
DY 9 Uncompensated Care Charity Care Survey (July 2019)
DY 9 UC Uninsured Charity Survey Hospitals (July 2019)
CMS Revised S-10 Reporting Instructions (Sept. 2017)
Texas Hospitals Urge Congress to Eliminate Medicaid DSH Cuts (Aug. 30, 2017)
THA Comments on Proposed Medicaid DSH Rules (Aug. 28, 2017)

Other

Supporting Web pages

Visit THA’s supporting Web pages for additional information on certain Medicaid and Medicare issues as well as hospital financing.

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Contact:

John Hawkins, senior vice president, government relations, 512/465-1505

Jennifer Banda, J.D., vice president of advocacy, public policy & political strategy, 512/465-1046

Richard Schirmer, FACHE, vice president of health care policy analysis, 512/465-1056

Anna Stelter, senior director of policy analysis, 512/465-1556