The Texas Health and Human Services Commission (HHSC) offers a vital program known as the Public Health Provider – Charity Care Program (PHP-CCP). This initiative is designed to provide financial reimbursement to qualified healthcare providers in Texas for delivering essential healthcare services when no other form of compensation is available. These critical services include behavioral health support, immunizations, and various preventative care measures. The Charity Care Program Texas operates under the authority of the 1115 waiver, ensuring its alignment with federal healthcare guidelines and standards.
Initially, in its first year, the program addressed both uncompensated care and Medicaid shortfalls. However, it has since evolved. Starting from Year 2, the PHP-CCP has specifically focused on reimbursing costs associated with charity care. This transition underscores the program’s commitment to supporting providers who offer crucial services to vulnerable populations without guaranteed payment.
Participation in the Texas charity care program requires providers to be publicly funded entities, certified to certify public expenditures. Eligible publicly owned and operated providers are those established under the Texas Health and Safety Code Chapters 533 and 534. These primarily include organizations delivering behavioral health services such as:
- 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 the Texas Health and Safety Code Chapter 121
Since October 1, 2021, the PHP-CCP has expanded to offer supplemental payments for specific medical services to certain providers. These funds are intended to alleviate the financial burden of uncompensated care costs incurred while serving Medicaid-eligible or uninsured individuals. For the fiscal year 2022, the total funding pool was capped at $500 million, based on allowable uncompensated care costs. Recognizing the actual expenses related to charity care, the program was resized for fiscal year 2023 with the approval of the Centers for Medicare and Medicaid Services (CMS). Consequently, the total funding available will not exceed $499.1 million (total computable dollars) for FY2023 and subsequent years. It’s important to note that this funding pool may be adjusted in the future to reflect the actual charity care costs incurred by participating providers.
Key Updates and Program Evolution
Federal Approval and Program Guidelines
The PHP-CCP received federal approval for its protocol from the Center for Medicaid and Medicare Services (CMS) on December 22, 2021. This federal endorsement is crucial for the program’s operation and legitimacy.
The operational methodologies and rules of the charity care program texas are outlined in §1 Texas Administrative Code (TAC) Section 355.8215. This section details the reimbursement process for qualified providers covering costs related to behavioral health, immunizations, chronic disease prevention, and other preventative services for uninsured populations.
Further details regarding payment availability for eligible providers to offset uncompensated charity care costs, starting October 1, 2022, are available in §1 TAC Section 355.8217.
Year 1 (DY11) and Uncompensated Care Reporting
In the initial year (DY11) of the PHP-CCP, training on uncompensated care cost reporting was conducted in August 2021. To be eligible for submitting the PHP-CCP cost reporting tool, organizations needed to have at least one trained individual.
For more details, providers can access the Year 1 training materials:
- Year 1 (DY11) PHP-CCP Training Slides (.pdf)
- PHP-CCP Cost Reporting Tool Supporting Documentation Companion Guide and FTP User Guide (.pdf)
Year 2 (DY12) Transition to Charity Care
A significant shift occurred in Year 2 (DY12) of the PHP-CCP, moving the focus exclusively to charity care reimbursement, transitioning away from broader uncompensated care. Starting in Year 2, participating providers were mandated to develop a charity care policy for their organization and submit it to HHSC along with the PHP-CCP Cost Reporting tool. This policy requirement ensures a structured approach to charity care provision.
Training webinars for Year 2 cost report preparation were held on August 15, 2023, August 22, 2023, and September 15, 2023. Annual training attendance by at least one financial contact is a prerequisite for program participation, as stipulated by 1 TAC Section 355.8217.
Year 2 marked the introduction of the State of Texas Automated Information Reporting System (STAIRS) for cost report submissions, commencing October 1, 2023. This online system replaced the previously used Excel spreadsheet, streamlining the reporting process. Providers are encouraged to familiarize themselves with the STAIRS platform.
Relevant documents for Year 2 include:
- Addendum to Attachment T (.pdf)
- Charity Care Transition PowerPoint slides (.pdf)
- Charity Care Sample Policy 1 (.pdf)
- Charity Care Sample Policy 2 (.pdf)
- Healthcare Financial Management Associated (HFMA) Hospital Charity Care and Financial Assistance Policy and Procedures (.pdf)
- Healthcare Financial Management Associated (HFMA) Statement 15 (.pdf) – Valuation and Financial Statement Presentation of Charity Care, Implicit Price Concessions and Bad Debts by Institutional Healthcare Providers.
- Year 2 (DY12) PHP-CCP Training Slides (.pdf).
For further inquiries, contact the PHP-CCP team.
Year 3 (DY13) Cost Report and STAIRS
The PHP-CCP Cost Report for Year 3 (FFY 2024) continues to utilize the STAIRS system for all cost report submissions.
For the FFY 2024 Cost Report, providers can use the Provider Name PHP-CCP Cost Report Documentation Template and Instructions (.xlsx) template to submit supporting documentation. Remember to replace “Provider Name” with your entity’s name when using this template and upload it within STAIRS.
HHSC has completed its initial review of the FFY 2024/DY 13 PHP-CCP Cost Reports. Providers can log in to STAIRS to review their adjusted Cost Reports and either accept the settlement amount or request an informal review.
Payment batches will be processed once the status of all PHP-CCP Cost Reports is finalized. Due to the CMS-approved funding limit of $499,193,023, a proportionate reduction will be applied to all Cost Report settlements. Current proportionate reduction estimates for FFY 2024 are available here. These reductions are not shown directly in STAIRS cost reports but are noted as a factor affecting total allowable costs.
Year 4 (DY14) Program Training and Updates
Training webinars for Year 4 of the PHP-CCP were conducted on August 13, 2024, August 20, 2024, and September 13, 2024. As mandated by 1 TAC §Section 355.8217, annual training for at least one financial contact is required for participation.
The Year 4 training included both program updates for FFY 2025 and a review of the Year 3 (FFY 2024) Cost Report submission process. Annual cost report training is essential for obtaining the necessary training credit to report information in STAIRS.
The FFY 2025 (DY14) Texas PHP-CCP Training Presentation (.pdf) is available for review.
For additional information or questions about the Texas charity care program, please email the PHP-CCP team or call 737-867-7999 to speak with a PFD staff member.
Important Note: The PHP-CCP does not offer direct financial assistance to individual patients. Individuals needing medical cost assistance should call 2-1-1 or visit www.211texas.org for support resources.
