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. In a Medicare or Medicaid fee-for-service model, payment rates to hospitals are administratively set instead of negotiated between providers and payers. Medicare and Medicaid both also feature supplemental payment opportunities, which boost low hospital base payments in these programs, which typically do not cover enrollees’ costs of care.
The Texas Legislature sets the Medicaid program budget for each biennium, and the Texas Health and Human Services Commission (HHSC) administers the base and supplemental payment programs that reimburse hospital care for low-income and uninsured Texans. THA works with the Texas Legislature on legislation that affects health care financing and helps shape the regulatory environment through involvement with specific Medicaid advisory committees, HHSC and the Texas Department of State Health Services.
In Medicare, the amount and manner of payments are governed by acts of Congress and the Centers for Medicare and Medicaid Services (CMS). THA engages the Texas congressional delegation on key Medicare issues and takes part in public comment opportunities put forth by CMS to safeguard hospitals’ Medicare payments.
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 (6/28/21) | THA
Medicaid Resources
General/Directed Payment Programs
- THA Comments on Proposed Rule 23R026 (7/24/2023) | THA
- 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)
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)
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 and Uncompensated Care
- Comments on Modification to Second Reassessment of Uncompensated Care Pool Program (6/12/23) | THA
- Comments on Proposed DSH Reimbursement Methodology Rule (5/17/21) | THA
- Proposed Medicaid DSH Reimbursement Methodology Rule (4/16/21) | HHSC
Medicaid DSH Payment Cuts
The Texas Hospital Association is asking Congress to address Medicaid disproportionate share hospital (DSH) cuts to help protect patient care. THA has calculated the number of DSH hospitals and reduction amounts for each of the 38 U.S. House districts for FY 2025. More information is available here.
Medicaid 1115 Waiver
The Centers for Medicare & Medicaid Services has renewed Texas’ Medicaid 1115 Waiver through September 2030. The waiver authorizes the state to operate Medicaid managed care and sets budgetary limits for several key supplemental payment programs, including state directed payment programs and Texas’ uncompensated care pool.
Although the waiver itself received 10-year approval, payment programs within the waiver must be reapproved or resized periodically. THA continues its advocacy with state and congressional leaders to preserve the state’s health care safety net.
Texas hospitals urge CMS to continue working with the state to achieve the following outcomes:
- Preserve a budget neutrality determination that permits sufficient safety-net hospital funding.
- 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)
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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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.