Directed Payment Programs

Uniform Hospital Rate Increase Program

Uniform Hospital Rate Increase Program is a statewide program that provides for increased Medicaid payment for inpatient and outpatient services. Texas Medicaid managed care organizations (MCOs) receive additional funding through their monthly capitation rate from HHSC and are directed to increase payment rates for certain hospitals.

Comprehensive Hospital Increase Reimbursement Program

The Comprehensive Hospital Increase Reimbursement Program replaces UHRIP beginning September 1, 2021. HHSC and stakeholders wanted to reform certain aspects of UHRIP, such as improving its tie to the state’s Medicaid quality strategy and incorporate the efforts to further healthcare transformation and quality improvement in the Medicaid program. CHIRP continues to be a statewide program that provides for increased Medicaid payments for inpatient and outpatient services to participating Texas hospitals. Texas Medicaid managed care organizations receive additional funding through their monthly capitation rate from HHSC and are directed to increase payment rates for enrolled hospitals. CHIRP is comprised of two payment components:

  • The Uniform Hospital Rate Increase Payment
  • The Average Commercial Incentive Award

The UHRIP component provides hospitals an increased payment that is based on a percentage of the Medicare gap, which is the difference between what Medicare is estimated to pay for the services and what Medicaid actually paid for the same services. The ACIA component is an optional component and hospitals can choose to participate. It provides hospitals a payment based on a percentage of the average commercial reimbursement gap 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. Enrollment for CHIRP begins March 15, 2021.

Quality Incentive Payment Program

Quality Incentive Payment Program is a statewide program that provides for incentive payments to qualifying nursing facilities. STAR+PLUS MCOs are directed to make payments to qualifying nursing facilities once the facilities demonstrate meeting the required goals.

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

HHSC created the Texas Incentives for Physicians and Professional Services program to replace Delivery System Reform Incentive Payment program and the Network Access Improvement Program that are ending in state fiscal years 2022 and 2023, respectively. TIPPS is a value-based directed payment program for certain physician groups providing health care services to persons enrolled in the STAR, STAR+PLUS and STAR Kids Medicaid programs. Eligible physician groups include: health-related institution physician groups, physician groups affiliated with hospitals that receive indirect medical education funding and other physician groups. These classifications allow HHSC to direct reimbursement increases where they are most needed and to align with the quality goals of the program. TIPPS payments are paid to MCOs through three components in their capitation rates and distributed to eligible physician groups based on each physician group meeting performance requirements. Component 1 is a monthly performance incentive payment based upon the implementation of quality improvement activities. Component 2 is a semi-annual performance incentive payment based on the achievement of quality metrics focused on primary care and chronic care. Health-related institutions and indirect medical education physician groups are the only classes eligible for Components 1 and 2.  Component 3 is a uniform rate increase on paid claims for certain outpatient services based on the achievement of quality metrics that measure aspects of maternal health, chronic care, behavioral health and social determinants of health. All participating physician groups are eligible for Component 3. Enrollment for TIPPS begins March 15, 2021.

Rural Access to Primary and Preventive Services

The Rural Access to Primary and Preventive Services is a directed payment program that incentivizes primary and preventive services for persons in rural areas of the state enrolled in the STAR, STAR+PLUS and STAR Kids Medicaid programs. RAPPS focuses on the management of chronic conditions. Two classes of Rural Health Clinics are eligible to participate:

  • Hospital-based RHCs, which include non-state government-owned and private RHCs
  • Free-standing RHCs

Eligible RHCs must serve an annual minimum volume of 30 Medicaid managed care encounters.  RAPPS is comprised of two payment components: Component 1 is a monthly prospective uniform dollar increase paid to all participating RHCs to promote improvement activities with a focus on improving access to primary and preventive care services. Providers report semi-annually on certain structure measures that include electronic health record use, telemedicine/telehealth capabilities, and care coordination. Component 2 is a uniform percent rate increase for certain services. Providers will report their progress on process measures for preventive care and screening and management of chronic conditions.

Directed Payment Program for Behavioral Health Services

HHSC created the Directed Payment Program for Behavioral Health to incentivize the Certified Community Behavioral Health Clinic model of care for persons enrolled in the STAR, STAR+PLUS and STAR Kids Medicaid programs. Eligible providers include Community Mental Health Centers. The Certified Community Behavioral Health Clinic model provides a comprehensive range of evidence-based mental health and substance use disorder services with an emphasis on offering 24-hour crisis care, care coordination with local primary care and hospital providers and integration with physical health care. The DPP BH is comprised of two payment components. Component 1 provides a monthly uniform dollar increase paid to all participating community mental health center providers in the program. Providers must report their progress towards gaining or maintaining certification for the Certified Community Behavioral Health Clinic model and other activities foundational to quality improvement, such as telehealth services, collaborative care, integration of physical and behavioral health, and improved data exchange. Component 2 is a uniform percent increase applied to certain Certified Community Behavioral Health Clinic services based on achieving quality metrics that align with its measures and goals.

CMS & HHSC 2021 Correspondence

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