April 6, 2022
CONTACT:
Jennifer Banda, senior vice president, advocacy and public policy, 512/465-1046
Anna Stelter, senior director, policy analysis, 512/465-1556
Sara Gonzalez, vice president, advocacy & public policy, 512/465-1596
Following federal approval late last month of three Medicaid directed payment programs, the Texas Hospital Association has learned more about when hospitals can expect to begin receiving the much-needed funding. Currently, health plans are manually loading rates hospital by hospital, line by line — a process that normally takes 90 days but one the plans have committed to completing for the Comprehensive Hospital Rate Increase Reimbursement Program (CHIRP) in 60 days. Every hospital should start receiving payments by June 1. Some hospitals may start receiving payments in as soon as six weeks, with around 25% of plans saying they will be able to complete rate loading faster than 60 days. THA has drafted an FAQ for Texas providers regarding payments from the approved DPPs — CHIRP, Texas Incentives for Physician and Professional Services (TIPPS), and Rural Access to Primary and Preventative Services (RAPPS). The Texas Health and Human Services Commission also recently issued details on the timelines for DPP payments.
As soon as a hospital’s rates are loaded in the system, payments can immediately begin. Hospitals should promptly begin seeing real-time claims with the DPP increase added. The pace of retroactive payments once they begin may be variable or uneven. The Texas Health and Human Services Commission has been assured by the plans that retroactive payments will be complete by the 120-day mark, 60 days after payments begin — with 60 days of rate loading followed by 60 days of reprocessing. With millions of claims in the queue, it is possible not every retroactive claim is reprocessed by this time, but delays should be minimal and isolated.
If a hospital has any outstanding paperwork or unexecuted contracts with plans, they should complete these as soon as possible. Plans cannot start payments to providers with incomplete paperwork, but otherwise the manual work of reprocessing is the responsibility of the managed care organization. Some hospitals may opt to perform a reconciliation on the processed claims to ensure the payments are in line with the amount expected from those claims, but this is not necessary to start the flow of payments.
If payments appear delayed or other issues arise, contact the plan to alert it of the issue. If the issue is not resolved in a timely manner, member hospitals are urged to escalate the issue to THA. The Texas Association of Health Plans has assured THA it will contact the plans immediately, as this is a top priority.
On March 25, the Centers for Medicare & Medicaid Services approved the three DPPs amounting to $5.3 billion a year in payment enhancements to Texas providers caring for Medicaid enrollees. The program approvals are retroactive to the beginning of state fiscal year 2022, which runs from Sept. 1, 2021, to Aug. 31, 2022. In announcing the decision, CMS noted the approvals do not constitute approval of any Medicaid managed care plan contracts or rate certifications for the period, or any specific Medicaid financing mechanism covering the non-federal share of the provider payment arrangement. Coinciding with announcement of the approvals, the U.S. Health and Human Services’ Office of Inspector General issued a letter notifying HHSC of its intent to conduct an audit of the state’s Local Provider Participation Funds. THA will continue to keep members up to date with all developments on this matter.
According to Texas Government Code 305.027, portions of this material may be considered “legislative advertising.” Authorization for its publication is made by John Hawkins, Texas Hospital Association, 1108 Lavaca, Ste. 700, Austin, Texas 78701-2180.