Medicaid is a program jointly funded by federal and state governments. The federal government pays states for a specific percentage of Medicaid expenditures, called the Federal Medical Assistance Percentage (FMAP). To receive federal funding, states must ensure they can fund the remaining amount of Medicaid expenditures. To do this, states may use either state or local government funds as the non-federal share of Medicaid funding.
Beginning in 2013 local governments received approval from the Texas Legislature to operate Local Provider Participation Funds (LPPFs). LPPFs are accounts that local units of government deposit mandatory payments from hospitals to use as an intergovernmental transfers (IGT) to HHSC. Hospitals that are not operated by a unit of government and provide inpatient services in each local jurisdiction pay into the fund, so the local jurisdiction can use this money as the non-federal portion of the Medicaid match. To date, multiple LPPFs are in operation across the state. Currently, LPPFs provide funding for several supplemental and directed payment programs, like Uncompensated Care supplemental payments and the Uniform Hospital Rate Increase Program.
LPPF Reporting Requirements
Since 2013 each legislative session has seen increases in the number of jurisdictions allowed to operate LPPFs. In 2019, House Bill 4289, Eighty-Sixth Legislature, Regular Session, 2019, provided authority for any jurisdiction not served by an LPPF to operate one.
As required by 2020–21 General Appropriations Act, Article II, Rider 26, Texas House Bill 4289, Eighty-sixth Legislature, 2019, and Texas Administrative Code Section 355.8068 all units of government operating an LPPF are required to report certain information to the Texas Health and Human Services Commission (HHSC). Per Rider 26 and Title 42 of the Code of Federal Regulations, §433.74, HHSC is required to report certain information related to Local Provider Participation Funds (LPPFs) to the Texas Legislature and CMS for each federal fiscal quarter.
LPPF Quarterly Reporting
Each unit of government operating a LPPF is required to submit a quarterly report with certain financial information to the Health and Human Services Commission. The report is due 10 days after the end of each federal fiscal quarter. A summary of the units of government that completed the reporting requirement is available and updated quarterly.
Reporting for Quarter 2 was impacted by the coronavirus (COVID-19) public health emergency. It was not subject to a deadline because the Office of the Governor temporarily waived the penalty for non-compliance with Texas Administrative Code §355.8068.
Frequently Asked Questions About LPPFs
What are LPPF mandatory payments?
Mandatory payments are financial assessments nonpublic hospitals pay based on their annual net patient revenue. Mandatory payments are collected by the unit of government operating the LPPF and can be used as the non-federal share of Medicaid payments for supplemental and directed payment programs like Uncompensated Care (UC) and Uniform Hospital Rate Increase Program (UHRIP).
The unit of government operating the LPPF determines the assessment rate annually. However, that rate cannot exceed 6 percent of total of the net patient revenue from all paying hospitals in district, county, or municipality.
What is an LPPF?
LPPFs are an optional method of finance for local governments to generate and collect local funding for Texas Medicaid supplemental and directed payment programs.
Which governmental entities operate LPPFs in Texas?
In 2019, House Bill 4289 provided authority statewide for all jurisdictions not served by an LPPF the ability to operate one. Twenty-eight jurisdictions have the authority to operate a Local Provider Participation Fund (LPPF); however, to date, only twenty-six LPPFs are operational.
- City of Amarillo Hospital District
- Angelina County
- City of Beaumont
- Bell County
- Bowie County
- Brazos County
- Cameron County
- Cherokee County (not operational)
- Dallas County
- Grayson County
- Gregg County
- Hays County
- Hidalgo County
- McLennan County
- Nueces County (not operational)
- Smith County
- Tarrant County
- Tom Green County
- Webb County
- Williamson County
- Lubbock County Hospital
- Ellis County
- Bexar County Hospital District
- Harris County Hospital District
- Wichita County
- Travis County
- Taylor County
- El Paso County Hospital District
What does a local government operating an LPPF need to do to transfer funds to the state?
To transfer funds to HHSC, a local governmental entity must set up a unique TexNet account for the LPPF. This account must be separate from their non-LPPF accounts. In addition to setting up a TexNet account, you must have a unique LPPF Texas Identification Number (TIN) with HHSC in the event an IGT refund would need to be issued. To set up a TexNet account, you can go to https://texnet.cpa.state.tx.us/. Forms you will need to set up a unique TIN are an application for Texas Identification Number (PDF) and Direct Deposit Authorization (PDF).
How can my local jurisdiction establish an LPPF?
Prior to 2019, local jurisdictions requested authorization from the Texas Legislature to operate an LPPF. A local jurisdiction would work with its local legislator to get a bill enacted authorizing the jurisdiction to establish one. The legislation would identify the LPPF governing body's statutory responsibilities and powers. In 2019, House Bill 4289 provided authority statewide for all jurisdictions not served by an LPPF the ability to operate one.
What regulations/laws do local governments operating an LPPF need to be aware of?
Rules governing LPPF reporting in the Texas Administrative Code can be found in Section 355.8068. For specific guidance regarding your local jurisdiction's LPPF, please refer to the authorizing statute that gave your jurisdiction the authority to create an LPPF. A list of legislation for each authorized LPPF and the year it was enacted can be found at the end of this document. You can look up legislation at: https://capitol.texas.gov/. In addition, please be familiar with federal regulations at 42 CFR 433.50 through 433.74.
What information do local governments operating LPPFs need to report to HHSC?
State law requires local governments operating LPPFs to report the following information on a quarterly basis to the Texas Health and Human Services Commission:
- the rate used to determine the mandatory payment
- a list of all paying hospitals
- the amount of the mandatory payment required of each paying hospital
- the amount of the mandatory payment received by the LPPF from each paying hospital
- the sum of the mandatory payments received by the LPPF
- the purpose for which the LPPF funds were expended or transferred and the amount and date for each transfer or expenditure.
Funds from an LPPF can be transferred to HHSC for which Medicaid programs?
There are two factors in determining whether LPPF funds may be used for Medicaid purposes. First, the enabling legislation of a particular LPPF must allow for a use. The legislation creating each LPPF varies. Check the specific bill of an LPPF to determine what restrictions may or may not exist regarding funding Medicaid programs. Second, HHSC must operate a program that accepts funds from an LPPF as the non-federal share of a Medicaid payment. To date, the following Medicaid programs may be funded via an LPPF, however more programs may be added in the future.
- Uncompensated Care
- UHRIP – Uniform Hospital Rate Increase Program
- DSRIP – Delivery System Reform Incentive Payment
Do all hospitals in a jurisdiction pay into an LPPF?
The type of hospital that makes mandatory payments is a nonpublic hospital that provides inpatient services. "Inpatient hospital services" is a recognized class of health care services according to 42 CFR §433.56. Any hospital that provides inpatient services that is licensed within a jurisdiction that operates an LPPF is required to make mandatory payments. HHSC is launching a reporting system to ensure that all members of the class are making mandatory payments on an ongoing basis.
Who can I contact at HHSC for general questions about LPPFs?
Send your questions to: LPPF@hhsc.state.tx.us
- Federal reporting requirements
- Permissible Health-related taxes
LPPF Reporting Portal Webinar Training
The webinar was held December 9 for units of government operating Local Provider Participation Funds. It demonstrates how to use the LPPF Reporting Portal by:
- Providing step-by-step instructions
- Reviewing portal functionality
- Identifying information and data to report
- Answering questions about the portal and information to report.
LPPF Reporting Portal Reference Guide (PDF)
This reference guide is to assist users to access and to use the LPPF Reporting Portal. The reference guide provides general information about the capabilities of portal. It is not a step-by-step guide, but some specific directions are included about what users can do if they forget their password and how to assign other users access to the Reporting Portal.
Local Provider Participation Fund Legislation and Year Enacted
|Cameron County||SB 1623||83R||2013|
|Hidalgo County||SB 1623||83R||2013|
|Webb County||SB 1623||83R||2013|
|City of Beaumont||SB 1387||84R||2015|
|Bell County||HB 2913||84R||2015|
|Bowie County||SB 1587||84R||2015|
|Brazos County||HB 3185||84R||2015|
|Cherokee County (not operational)||SB 1587||84R||2015|
|Gregg County||SB 1587||84R||2015|
|Hays County||HB 3175||84R||2015|
|McLennan County||HB 2809||84R||2015|
|City of Amarillo Hospital District||SB 2117||85R||2017|
|Angelina County||HB 2995||85R||2017|
|Dallas County||HB 4300||85R||2017|
|Grayson County||HB 2062||85R||2017|
|Smith County||HB 2995||85R||2017|
|Tarrant County||SB 1462||85R||2017|
|Tom Green County||HB 3398||85R||2017|
|Williamson County||HB 3954||85R||2017|
|Lubbock County Hospital||SB 2448||86R||2019|
|Ellis County||HB 4548||86R||2019|
|Bexar County Hospital District||SB 1545||86R||2019|
|Harris County Hospital District||HB 3459||86R||2019|
|Wichita County||SB 2286||86R||2019|
|Travis County||SB 1350||86R||2019|
|Taylor County||HB 1142||86R||2019|
|Nueces County Hospital District (not operational)||SB 2315||86R||2019|
|El Paso County Hospital District||SB 1751||86R||2019|