Medicaid & CHIP Directed Payment Programs

Directed Payment Programs are designed to help Medicaid managed care programs achieve delivery system and payment reform and performance improvement. Texas Medicaid and CHIP currently administer the Quality Improvement Payment Program and have proposed four additional DPPs to CMS for approval.

Comprehensive Hospital Increased Reimbursement Program (CHIRP)

CHIRP is a directed payment program for hospitals providing healthcare services to adults and children enrolled in STAR and STAR+PLUS. Eligible hospitals include children's hospitals, rural hospitals, mental health hospitals, state-owned hospitals, and urban hospitals. The program is a change to the existing Uniform Hospital Rate Increase Program, currently in its fourth year of operation.

HHSC is proposing the DPP begin September 1, 2021. All programs are subject to CMS approval.

Directed Payment Program for Behavioral Health Services (DPP BHS)

The DPP BHS is a value-based directed payment program for community mental health centers to promote and improve access to behavioral health services, care coordination, and successful care transitions. It also incentivizes continuation of care for STAR, STAR+PLUS, and STAR Kids members using the Certified Community Behavioral Health Clinic model of care.

HHSC is proposing the DPP begin September 1, 2021. All programs are subject to CMS approval.

Quality Improvement Payment Program (QIPP)

QIPP is an incentive payment program for Texas nursing facilities serving residents enrolled in the STAR+PLUS Medicaid managed care program. Providers earn payments for meeting participation and performance requirements across four components: quality assurance and performance improvement, workforce development, minimum data set quality measures, and infection control. Non-state government-owned facilities are eligible to participate in all four components, while privately owned facilities that meet Medicaid utilization requirements are eligible for two out of four components. QIPP was first implemented on September 1, 2017. Component structure and quality measures must be approved annually by CMS.

Rural Access to Primary and Preventive Services Program (RAPPS)

RAPPS is a directed payment program for rural health clinics that provide primary care and long-term care services to STAR, STAR+PLUS, and STAR Kids members.

HHSC is proposing the DPP begin September 1, 2021. All programs are subject to CMS approval.

Texas Incentives for Physicians and Professional Services (TIPPS)

TIPPS is a value-based directed payment program for certain physician groups providing health care services to children and adults enrolled in the STAR, STAR+PLUS and STAR Kids Medicaid programs. Eligible physician groups include health-related institutions, indirect medical education physician groups affiliated with hospitals and other physician groups.

HHSC is proposing the DPP begin September 1, 2021. All programs are subject to CMS approval.