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 355.8215 - Public Health Provider - Charity Care Program (PHP-CCP)

Current through Reg. 49, No. 28; July 12, 2024
(a) Introduction. This section establishes
					 the Public Health Provider - Charity Care Program (PHP-CCP). PHP-CCP is
					 designed to allow qualified providers to receive reimbursement for the cost of
					 delivering healthcare services, including behavioral health services, vaccine
					 services, public health services, and other preventative services, when those
					 costs are not reimbursed by another source. The program is authorized under the
					 1115 waiver.
(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)
					 Medicaid shortfall--The unreimbursed cost to a qualifying provider of providing
					 Medicaid services to Medicaid clients.
(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
					 costs--The sum of the Medicaid shortfall and the uninsured costs.
(9) Uncompensated care payments--Payments
					 intended to defray the uncompensated costs of providing services.
(10) Uncompensated care tool--A form
					 prescribed by HHSC to identify uncompensated costs for Medicaid-enrolled
					 providers and used to enroll in the program.
(11) Uninsured costs--The unreimbursed cost
					 to a qualifying provider of providing services that meet the definition of
					 "medical assistance" in Social Security Act §1905(a) to uninsured patients
					 as defined by CMS.
(12) 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).
(13) Waiver--The Texas Healthcare
					 Transformation and Quality Improvement Program Medicaid demonstration waiver
					 under Social Security Act §1115.