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.
Resources
Medicare Resources
- Comments Responding to CMS Request for Information on Medicare Advantage (8/30/2022) | THA
- 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)
Medicaid Resources
General/Directed Payment Programs
- DPP Approval: The First Step in Securing Texas’ Safety Net (4/20/2022) | THA
- Information Alert: THA Issues Latest Information on DPP Payments (4/6/2022) | THA
- Information Alert: CMS Approves Three DPPs (3/25/2022) | THA
- Critical Funding Remains in Limbo as Pandemic Wears On (2/17/2022) | THA
- Withholding Hospital Funds Hurts Patients (2/7/22) | THA
- Texas House Members Submit Letters to CMS on 1115 Waiver (1/24/22)
- Joint Letter to Congressman Gonzalez RE: Healthcare Coverage Gap (1/20/22)
- THA Response to Sen. Cruz on Build Back Better Provisions (1/13/22)
- Texas Senate Members Issue Letter on Medicaid Funding and 1115 Waiver (12/8/21)
- THA Letter on Build Back Better Provisions & Waiver Negotiations (12/1/21)
- Multi-association Letter Against Certain BBB Provisions (11/5/21)
- 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
- 2023 CHIRP Application (PDF) (March 2, 2022) | HHSC
- 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 Preventative 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
- THA Comments on Local Funds Monitoring Program Proposed Rule (Feb. 14, 2022)
- Texas Medicaid in Perspective Handout(January 2017)
- THHSC Proposed Methodology and Measures for 2018 Medical Pay-for-Quality Redesign
- 2018 Pay-for-Quality Program Measures and Benchmarks
- HHS Nondiscrimination Final Rule Summary (September 2016)
- Summary of Securing Funding for Increased Medicaid Reimbursement Rates in the 84th Legislature
Medicaid 1115 Waiver
The Centers for Medicare & Medicaid on April 16, 2021, rescinded the 10-year extension of Texas’ Medicaid 1115 Waiver that the previous administration approved in January 2021. While the current waiver and its uncompensated care pool continued through Sept. 30, 2022, THA continues its advocacy with state and congressional leaders in support of another extension.
Texas hospitals urge CMS to work with the state to reapprove its waiver extension and achieve the following outcomes:
- Grant an equivalent or better budget neutrality determination.
- Sustain a strong hospital uncompensated care pool.
- Reinforce the behavioral heath safety net.
- Recognize the waiver as a building block to comprehensive health care coverage.
10-Year Extension (DYs 10-19/Jan 2021 – Sept. 2030)
DYs 7-10 (Dec. 2017-Jan. 2021)
CMS Disallowance of Uncompensated Care Payments
The Departmental Appeals Board at the U.S. Department of Health and Human Services decided in early August 2018 to uphold CMS’ earlier decision to disallow approximately $25 million in federal uncompensated care payments to private hospitals in the Dallas-Fort Worth area. At this time, the state Medicaid agency is considering its options and could accept the decision or appeal.
History:
In September 2014, CMS notified HHSC that it was deferring $74 million in federal Medicaid funds tied to private hospital uncompensated care payments from 2013 under the waiver. While it did not accept the financial arrangement, CMS ultimately released the deferral in January 2015 and stated its willingness to work with HHSC before making a final determination.
In May 2015, HHSC and CMS revisited the issue. Shortly thereafter, CMS agreed that if changes to private hospital funding were required following the discussions, Texas would have until Sept. 1, 2017 to transition to other funding mechanisms without risk of disallowance on the same grounds as the 2014 deferral. Discussions concluded in September 2015 without CMS’ authorization of the private hospital funding arrangement in question.
In September 2016, CMS issued another disallowance notice to HHSC stating that $27 million in federal uncompensated care payments were being disallowed because they constituted “impermissible provider donations.”
DY 6 (Sept. 2016-Dec. 2017)
Supporting Web pages
Visit THA’s supporting Web pages for additional information on certain Medicaid and Medicare issues as well as hospital financing.
According to Texas Government Code 305.027, portions of this material may be considered “legislative advertising.” Authorization for its publication is made by Jennifer Banda, J.D., Texas Hospital Association, 1108 Lavaca, Suite 700, Austin, TX 78701-2180.