Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 355 - REIMBURSEMENT RATES › Subchapter J - PURCHASED HEALTH SERVICES › Division 11 - TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT › Section 355.8217 - Payments to Public Health Providers for Charity Care

Current through Reg. 49, No. 28; July 12, 2024
(a) Introduction. Beginning October 1, 2022,
					 Public Health Provider - Charity Care Program (PHP-CCP) payments are available
					 under this section for eligible providers to help defray the uncompensated
					 costs of charity care. PHP-CCP payments to eligible providers for uncompensated
					 care before October 1, 2022, are described in §355.8215 of this division
					 (relating to the Public Health Provider - Charity Care Program
					 (PHP-CCP)).
(b) Definitions. The
					 following words and terms, when used in this section, have the following
					 meanings, unless the context clearly indicates otherwise.
(1) Centers for Medicare and Medicaid
					 Services (CMS)--The federal agency within the United States Department of
					 Health and Human Services responsible for overseeing and directing Medicare and
					 Medicaid, or its successor.
(2)
					 Charity care--Healthcare services, including behavioral health services,
					 vaccine services, public health services, and other preventative services,
					 provided without expectation of reimbursement to uninsured patients who meet
					 the provider's charity-care policy. The charity-care policy should adhere to
					 the charity-care principles of the Healthcare Financial Management Association
					 Principles and Practices Board Statement 15 (December 2019). Charity care
					 includes full or partial discounts given to uninsured patients who meet the
					 provider's financial assistance policy. Charity care does not include bad debt,
					 courtesy allowances, or discounts given to patients who do not meet the
					 provider's charity-care policy or financial assistance policy.
(3) Preventative services--For clients 21
					 years of age or older, services described in Section 9.2.56.3.2, Preventative
					 Care Visits of the Texas Medicaid Provider Procedures Manual as of the
					 effective date of this section. For clients birth through 20 years of age,
					 services covered under the Early and Periodic Screening, Diagnosis, and
					 Treatment (EPSDT) service.
(4)
					 Program period--A period of time for which eligible and enrolled providers may
					 receive the PHP-CCP amounts described in this section. Each PHP-CCP period is
					 equal to a Federal Fiscal Year (FFY) beginning October 1 and ending September
					 30 of the following year.
(5)
					 Public health services--Services designed to protect and promote the general
					 population's health and to prevent higher cost interventions such as
					 hospitalizations. These services include, but are not limited to, tuberculosis
					 identification, diagnosis, and treatment; sexually transmitted diseases
					 identification, diagnosis, and treatment; immunization (clinical services and
					 administration); dental care; and chronic disease screening, monitoring, and
					 self-management.
(6) Qualifying
					 Providers--Publicly-owned and operated Community Mental Health Clinics (CMHCs),
					 community centers, Local Behavioral Health Authorities (LBHAs), and Local
					 Mental Health Authorities (LMHAs) that are established under the Texas Health
					 & Safety Code Chapter 533 or 534 and are primarily providing behavioral
					 health services, and publicly-owned and operated Local Health Departments
					 (LHDs) and Public Health Districts (PHDs) that are established under the Texas
					 Health and Safety Code Chapter 121.
(7) Total program value--The maximum amount
					 available under PHP-CCP for a program period, as determined by the Texas Health
					 and Human Services Commission (HHSC) and CMS.
(8) Uncompensated care payments--Payments
					 intended to defray the charity care costs as defined in paragraph (3) of this
					 subsection.
(9) Uncompensated care
					 tool--A form prescribed by HHSC to identify charity care costs for
					 Medicaid-enrolled providers and used to enroll in the program.
(10) Uninsured patient--An individual who has
					 no health insurance or other source of third-party coverage for the services
					 provided. The term includes an individual enrolled in Medicaid who received
					 services that do not meet the definition of "medical assistance" in the Social
					 Security Act §1905(a).
(11)
					 Waiver--The Texas Healthcare Transformation and Quality Improvement Program
					 Medicaid demonstration waiver under Social Security Act §1115.