Directed Payment Programs

Comprehensive Hospital Increase Reimbursement Program

The Comprehensive Hospital Increase Reimbursement Program (CHIRP) replaced the Uniform Hospital Rate Increase Program beginning September 1, 2021. CHIRP provides increased Medicaid payments to hospitals for inpatient and outpatient services provided to persons enrolled in STAR and STAR+PLUS. Six classes of providers are eligible to participate: (1) children’s hospitals, (2) rural hospitals, (3) state-owned hospitals that are not institutions for mental diseases (IMDs), (4) urban hospitals, (5) non-state-owned IMDs, and (6) state-owned IMDs.

CHIRP funds are paid through two components of the managed care capitation rates:

The Uniform Hospital Rate Increase Payment component provides a uniform rate increase payment that is based on a percentage of the Medicare gap (the difference between what Medicare is estimated to pay for the services and what Medicaid actually paid for the same services).
The Average Commercial Incentive Award component is an optional component. It provides a uniform rate increase payment that is based on a percentage of the average commercial reimbursement (ACR) gap (the difference between what an average commercial payor is estimated to pay for the services and what Medicaid actually paid for the same services), less payments received under the UHRIP component. ACIA payments are capped at 90 percent of the total estimated ACR for the hospital class.

A participating hospital must report on all quality measures in the components for which it is eligible as a condition of participation in the program. On July 31, 2023, the Centers for Medicare & Medicaid Services (CMS) approved CHIRP for the program period covering September 1, 2023 to August 31, 2024, which is the seventh year of the program.

Quality Incentive Payment Program

The Quality Incentive Payment Program (QIPP) is a performance-based payment program designed to incentivize nursing facilities to improve the quality and innovation of their services. QIPP is a statewide program that provides incentive payments to qualifying nursing facilities. Two classes of providers are eligible to participate: (1) non-state government-owned nursing facilities, and (2) private nursing facilities.

QIPP funds are paid through four components of the STAR+PLUS managed care capitation rates:

Component 1 is equal to 110 percent of the estimated amount of the non-federal share and provides a uniform rate increase payment paid monthly. Only non-state government-owned nursing facilities are eligible for Component 1.
Component 2 is equal to 40 percent of the remaining QIPP funds after accounting for the funding of Components 1 and 4. It provides a monthly payment that is triggered by achievement of performance requirements.
Component 3 is equal to 60 percent of the remaining QIPP funds after accounting for the funding of Components 1 and 4. It provides a quarterly payment that is triggered by achievement of performance requirements.
Component 4 is equal to 16 percent of the total value of the program and provides a quarterly payment that is triggered by achievement of performance requirements. Only non-state government-owned nursing facilities are eligible for Component 4.

On July 31, 2023, CMS approved QIPP for the program period covering September 1, 2023 to August 31, 2024, which is the seventh year of the program.

Network Access Improvement Program

Network Access Improvement Program is a pass-through payment program designed to further the state's goal of increasing the availability and effectiveness of primary care for persons with Medicaid. NAIP accomplishes this by incentivizing health-related institutions and public hospitals to provide quality, well-coordinated, and continuous care in exchange for additional funding.

Texas Incentives for Physicians and Professional Services

The Texas Incentives for Physicians and Professional Services (TIPPS) program provides increased Medicaid payments to certain physician groups providing health care services to persons enrolled in STAR, STAR+PLUS, and STAR Kids. Three classes of providers are eligible to participate: (1) health-related institution physician groups, (2) physician groups affiliated with hospitals that receive indirect medical education funding, and (3) other physician groups.

TIPPS funds are paid through three components of the managed care capitation rates:

Component 1 is equal to 65 percent of the total program value and provides a uniform dollar increase paid monthly. Only health-related institutions and indirect medical education physician groups are eligible for Component 1.
Component 2 is equal to 25 percent of the total program value and provides a uniform rate increase paid semi-annually. Only health-related institutions and indirect medical education physician groups are eligible for Component 2.
Component 3 is equal to 10 percent of the total program value and provides a uniform rate increase for applicable outpatient services and is paid at the time of claim adjudication. All participating physician groups are eligible for Component 3.

A participating physician group must report on all quality measures in the components for which it is eligible as a condition of participation in the program. On July 31, 2023, CMS approved TIPPS for the program period covering September 1, 2023 to August 31, 2024, which is the third year of the program.

Rural Access to Primary and Preventive Services

The Rural Access to Primary and Preventive Services (RAPPS) program is designed to incentivize rural health clinics (RHCs) that provide primary and preventive care services to persons in rural areas of the state enrolled in STAR, STAR+PLUS and STAR Kids. Two classes of providers are eligible to participate: (1) Hospital-based RHCs, which include non-state government-owned and private RHCs, and (2) Free-standing RHCs.

RAPPS funds are paid through two components of the managed care capitation rate:

Component 1 is equal to 75 percent of the total program value and provides a uniform dollar increase paid monthly that is based on RHC class.
Component 2 is equal to 25 percent of the total program value and provides a uniform rate increase on applicable services.

A participating RHC must report on all quality measures as a condition of participation in the program. On July 31, 2023, CMS approved RAPPS for the program period covering September 1, 2023 to August 31, 2024, which is the third year of the program.

Directed Payment Program for Behavioral Health Services

The Directed Payment Program for Behavioral Health Services (DPP BHS) is designed to promote and improve access to behavioral health services, care coordination, and successful care transitions for individuals enrolled in STAR, STAR+PLUS and STAR Kids. Two classes of providers are eligible to participate: (1) Community Mental Health Centers (CMHCs) and Local Behavioral Health Authority (LBHAs) with the Certified Community Behavioral Health Center (CCBHC) certification, and (2) CMHCs and LBHAs without CCBHC certification.

DPP BHS funds are paid through two components of the managed care capitation rates:

Component 1 is equal to 65 percent of the total program value and provides a uniform dollar increase paid monthly.
Component 2 is equal to 35 percent of the total program value and provides a uniform rate increase applied to certain CCBHC services and is paid at the time of claim adjudication.

A participating provider must report on all quality measures as a condition of participation. On July 31, 2023, CMS approved DPP BHS for the program period covering September 1, 2023 to August 31, 2024, which is the third year of the program.