The healthcare landscape can be intricate, especially for public health providers dedicated to serving communities in Texas. Navigating funding and reimbursement for essential services is crucial. This guide delves into the Texas Health and Human Services Commission (HHSC) Public Health Provider – Charity Care Program (PHP-CCP), a vital initiative designed to support these providers. Understanding the nuances of the PHP-CCP can empower eligible organizations to secure reimbursements for delivering critical healthcare services to vulnerable populations.
Understanding the PHP-CCP: Supporting Texas Public Health
The Texas Health and Human Services Commission’s Public Health Provider – Charity Care Program (PHP-CCP) stands as a cornerstone of support for qualified healthcare providers in Texas. This program is specifically structured to reimburse providers for the costs associated with delivering essential healthcare services when no other source of reimbursement is available. These crucial services encompass behavioral health, immunizations, and a range of preventative care measures. Operating under the authority of the 1115 waiver, the PHP-CCP plays a pivotal role in ensuring access to care for underserved populations.
Initially, the program’s first year addressed both uncompensated care and Medicaid shortfalls. However, in its second year and onward, the PHP-CCP refined its focus to exclusively reimburse charity care. This transition underscores the program’s commitment to directly supporting providers in their efforts to deliver care to those who would otherwise go without.
Who is Eligible for the Charity Care Program?
Eligibility for the PHP-CCP is clearly defined to ensure that public funds are directed to providers who are integral parts of the state’s healthcare safety net. According to the 1115 waiver stipulations, participating providers must be backed by a unit of government capable of certifying public expenditures. This framework primarily includes publicly owned and operated providers established under Texas Health and Safety Code Chapters 533 and 534, particularly those focused on delivering behavioral health services. Eligible entities include:
- Community Mental Health Clinics (CMHCs)
- Community Centers
- Local Behavioral Health Authorities (LBHAs)
- Local Mental Health Authorities (LMHAs)
- Local Health Departments (LHDs) and Public Health Districts (PHDs) established under Texas Health and Safety Code Chapter 121
This targeted eligibility ensures that the charity care program effectively supports the public entities most directly involved in providing essential health services within Texas communities.
Expanding Support: Supplemental Payments for Medical Services
Since October 1, 2021, the PHP-CCP has broadened its scope to offer supplemental payments for specific medical services delivered by eligible providers. This expansion is designed to further alleviate the financial strain of uncompensated care costs incurred when serving Medicaid-eligible or uninsured individuals. These supplemental payments are drawn from a designated pool, which for FY22, was capped at $500 million based on allowable uncompensated care costs.
Recognizing the evolving needs and actual charity care costs, the program underwent resizing for FY2023, a change approved by the Centers for Medicare and Medicaid Services (CMS). Consequently, the total funding for FY2023 and subsequent years is capped at $499.1 million (total computable dollars). It’s important to note that this funding pool is subject to further adjustments in future years to accurately reflect the real charity care costs borne by eligible providers. This adaptive approach ensures the program remains responsive to the financial realities faced by public health providers.
Navigating the Program: Key Methodologies and Rules
The operational framework of the PHP-CCP is meticulously outlined in regulations adopted by HHSC. Specifically, §1 Texas Administrative Code (TAC) Section 355.8215 serves as the guiding rule for the program under the 1115 waiver. This section details the reimbursement process for qualifying providers for costs linked to providing care. These eligible costs encompass behavioral health, immunizations, chronic disease prevention, and other crucial preventative services for uninsured individuals.
Further elaborating on the program’s financial aspects, §1 TAC Section 355.8217 specifies the availability of PHP-CCP payments to help eligible providers offset the uncompensated costs of charity care, commencing from October 1, 2022. These regulatory sections provide the essential legal and operational structure for the charity care program, ensuring transparency and accountability in its implementation.
Key Years and Program Evolution: Staying Updated
To effectively participate in the PHP-CCP, understanding its year-by-year evolution is crucial. The program has seen significant developments and updates in recent years, particularly in its transition towards focusing solely on charity care reimbursement and the implementation of the STAIRS reporting system.
Year 1 (DY11): Uncompensated Care Focus
The initial year of the PHP-CCP focused on uncompensated care. Crucially, providers were required to have at least one trained individual within their organization to submit cost reports. Training sessions were conducted to equip providers with the necessary skills for cost reporting.
Year 2 (DY12): Transition to Charity Care and STAIRS
Year 2 marked a significant shift as the PHP-CCP transitioned to focus exclusively on charity care. This transition mandated that participating providers establish a charity care policy for their organization and submit it to HHSC alongside the cost reporting tool. Furthermore, Year 2 saw the introduction of the State of Texas Automated Information Reporting System (STAIRS) for cost report submissions, replacing the previous Excel-based system. Annual cost report training became a mandatory requirement for at least one financial contact from each provider organization.
Year 3 (DY13): STAIRS and Funding Adjustments
Year 3 continued the use of the STAIRS system for cost reporting. Providers were given the option to utilize a documentation template to streamline the submission of supporting documentation. A key development in Year 3 was the implementation of proportionate reductions to cost report settlements due to federal funding limitations. This adjustment, while necessary, underscored the importance of understanding program funding caps.
Year 4 (DY14): Annual Training and Continued Compliance
Year 4 emphasized the importance of annual training. Providers are required to ensure at least one financial contact attends the annual training sessions to maintain program compliance and reporting eligibility. Training sessions in Year 4 also included reviews of the Year 3 cost report submission process, reinforcing best practices and addressing common questions.
Accessing Assistance: PHP-CCP Resources and Contact Information
It’s important to note that the PHP-CCP is not designed to provide direct financial assistance to individual patients. Individuals seeking patient assistance are encouraged to dial 2-1-1 or visit 211texas.org for guidance and resources.
For providers seeking detailed information or support regarding the PHP-CCP, the HHSC offers dedicated channels for assistance. Providers can reach out to the PHP-CCP team via email at [email protected] for inquiries and support. Additionally, providers can call 737-867-7999 to speak directly with a PFD staff member specializing in the PHP-CCP. These contact points are invaluable resources for navigating program requirements, clarifying eligibility questions, and ensuring successful participation in the charity care program.
By staying informed and utilizing available resources, Texas public health providers can effectively leverage the PHP-CCP to sustain and expand their vital services to communities in need.
