Transcript Slide 1

Up Close and Personal:
Medicaid 1115 Transformation Waiver
Michelle Apodaca, JD
Vice President
Texas Hospital Association
John Berta
Sr. Policy Analyst
Texas Hospital Association
August 23, 2012
Today’s Presentation
I.
The Texas Budget
II.
Medicaid Managed Care Expansion
III.
Transformation Waiver
I.
Background
II.
Regional Partnerships
III.
Transition Payments
IV.
UC Tool
V.
Program Funding Protocol
VI. DSRIP
IV. Timeline
2
Factors Driving the Budget Shortfall
 Structural deficit – business margins tax
 Sales tax projections down over biennium
– Sales taxes are 56% of state revenue
 Teacher and state employee retirement and
health care costs have skyrocketed
 Increased demand for services as state
population grows, ages
 Loss of enhanced FMAP
under federal stimulus act
3
Factors Driving the Medicaid Shortfall
4
The Texas Budget
 2012-13 Shortfall approximately $27B
 Projected $72B in available revenue to fund an
estimated $99B in current services
 Current services impacted by Medicaid caseload
growth, public school enrollment, etc.
 Historically dire budget situation – 2003 shortfall
was “only” $10B resulting in significant cuts
 House and Senate both filed initial versions of
budget that assumed no new revenue
5
FY 2012-13 is a Balanced Budget
 Substantial $4.7B under-funding of Medicaid
– Expected to be made up through supplemental
appropriation in 2013 (Rainy Day Fund)
– Implications on 2014-15 Budget
 Spending reductions
– Cost-containment initiatives
– Medicaid managed care expansion statewide
6
2012-13 Hospital Rate Cuts
 8% rate cut for hospitals (added to 2% cut in
2010-11)
– Rural and children’s hospitals paid at cost
 Statewide hospital SDA implementation for 9/1
($30M savings - $20M mitigation)
 Expansion of Medicaid managed care ($386M
GR in savings)
 Medicaid cost savings implemented (non-
emergent care, OB 39 weeks, O/P Xover)
7
Medicaid APR-DRGs
 All Patient Refined DRGs
 Acute Care Hospitals - 9/1/2012
 Children’s Hospitals – 9/1/2013
 HHSC views APR-DRG Methodology
superior
 Increased DRG assignments for Mothers and
Newborns
 3M Proprietary Product
8
Today’s Presentation
I.
The Texas Budget
II.
Medicaid Managed Care Expansion
III.
Transformation Waiver
I.
Background
II.
Regional Partnerships
III.
Transition Payments
IV.
UC Tool
V.
Program Funding Protocol
VI. DSRIP
IV. Timeline
9
Medicaid Managed Care Expansion
–Expand existing service delivery areas to
contiguous counties (9/11)
–Expand STAR+PLUS to Lubbock and El
Paso (3/12)
–Expand STAR and STAR+PLUS to
South Texas (3/12)
–Convert PCCM areas to the STAR
program model (3/12)
–Include in-patient hospital services in
STAR+PLUS (no carve-out) (3/12)
10
Rural Hospitals – Rider 40
40. Payments to Hospital Providers. Until HHSC implements a new inpatient
reimbursement system for Fee-for-Service (FFS) and Primary Care Case Management
(PCCM) or managed care, including but not limited to health maintenance organizations
(HMO) inpatient services, hospitals that meet one of the following criteria: 1) located in a
county with 50,000 or fewer persons according to the U.S. Census, or 2) is a Medicaredesignated Rural Referral Center (RRC) or Sole Community Hospital (SCH), that is not
located in a metropolitan statistical area (MSA) as defined by the U.S. Office of
Management and Budget, or 3) is a Medicare-designated Critical Access Hospital
(CAH), shall be reimbursed based on the cost-reimbursement methodology authorized
by the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) using the most recent
data. Hospitals that meet the above criteria, based on the 2000 decennial census, will
be eligible for TEFRA reimbursement without the imposition of the TEFRA cap for
patients enrolled in FFS and PCCM. For patients enrolled in managed care other than
PCCM, including but not limited to health maintenance organizations (HMO), inpatient
services provided at hospitals meeting the above criteria will be reimbursed at
the Medicaid reimbursement calculated using each hospital's most recent FFS
rebased full cost Standard Dollar Amount for the biennium.
11
Managed Care Expansion Ramifications
 Expansion of managed care statewide threatened
supplemental Upper Payment Limit (UPL) payments
 HHSC secured a Medicaid Section 1115 demonstration
waiver to expand managed care statewide and to continue
hospital Medicaid supplemental funding
 Waiver provides the opportunity to initially receive current
levels of funding while providing for a transition to a hospital
performance and quality-based payment system
 HHSC will continue to facilitate the state matching share
through local IGTs to secure federal matching funds
12
Today’s Presentation
I.
The Texas Budget
II.
Medicaid Managed Care Expansion
III.
Transformation Waiver
I.
Background
II.
Regional Partnerships
III.
Transition Payments
IV.
UC Tool
V.
Program Funding Protocol
VI. DSRIP
IV. Timeline
13
1115 Demonstration Waiver
 Demonstration Waiver: an exemption from
certain federal rules that allows policymakers to
experiment with the Medicare and Medicaid
programs on a pilot study basis.
The Centers for Medicare and Medicaid Services
 “Our concern would be if the demonstration
turns into riots or damage”
British Transport Police Authority
14
Medicaid 1115 Waiver - Background
Waiver Goals
II. Funding Sources
III. Regional Administration
IV. Funding Uses
I.
I.
Uncompensated Care
II.
Delivery System Reform
V. Key Waiver Documents
15
Waiver Goals
 Expand risk-based managed care statewide
 Support the development and maintenance of a coordinated
care delivery system
 Improve outcomes while containing cost growth
 Protect and leverage financing to improve and prepare the
health care infrastructure to increase access to services
 Transition to quality based payment systems in managed care
and in hospital payments
 Provide a mechanism for investments in delivery system
reform including improved coordination in the current indigent
care system in advance of health care reform
16
1115 Waiver Funding – Sources
 Funds in the pools
–Current trended UPL based on
aggregate limit
–New funds associated with UPL from
former urban STAR managed care
areas
–New funds associated with managed
care savings
17
Regional Health Partnerships (RHP)
 The waiver will be implemented through
Regional Health Partnerships that:
– Are primarily organized by public/transferring
hospitals and other local government entities;
– Create regional assessment, planning and
redesign infrastructure; and
– Include private hospitals and health stakeholders
in regional health assessments, system redesign,
system investments and reporting on outcomes.
18
Regional Healthcare Partnerships
19
1115 Waiver Funds – Uses
Two sub-parts to the funding pool:
 Uncompensated Care (UC) – more
payments from this pool in first years of five
year waiver
 Delivery System Reform Incentive
Payments (DSRIP) – shifting to more
payments from this pool in later waiver years
20
Waiver Funding Overview
Waiver Pool
Uncompensated
Care Pool
Pays hospitals for
cost of care not
compensated by
Medicaid directly or
through DSH
Inpatient
Outpatient
Pharmacy
Clinic
Physician
Hospitals eligible
for funding must
commit to
investing in
system
transformation
Hospitals must
participate in a
regional
healthcare
partnership to
receive funds from
either pool
Delivery System
Reform Incentive
Pool
Pays hospitals
for achieving
metrics that
move toward
the triple aim
Category 1 – Infrastructure
Development
Category 2 – Program
Innovation & Redesign
Category 3 – Quality
Improvements
Category 4 – Population
Focused Improvements
21
Waiver Funding - $29 Billion
22
Key Waiver Documents
 Uncompensated Care (UC) Protocol
 Tool for reimbursement of costs of care provided to individuals without
coverage
 CMS approved hospital and physician tools July 16, 2012
 Dental and Emergency Medical Services (EMS) tools in process
 Program Funding and Mechanics Protocol
 Organization and requirements of the RHP Plans
 RHP Planning Protocol
 Menu of projects, milestones and metrics/measures eligible for
Delivery System
 Reform Incentive Payment (DSRIP) are made from this document
23
Today’s Presentation
I.
The Texas Budget
II.
Medicaid Managed Care Expansion
III.
Transformation Waiver
I.
Background
II.
Regional Partnerships
III.
Transition Payments
IV.
UC Tool
V.
Program Funding Protocol
VI. DSRIP
IV. Timeline
24
Regional Healthcare Partnerships
25
RHP Parties
 Anchor--The entity that generally makes intergovernmental
transfers to help fund waiver payments and has primary
administrative responsibilities on behalf of the RHP.
 IGT entity--A governmental entity that provides an IGT to
fund the waiver. IGT entities include hospital districts,
counties, public hospitals, public health districts, local mental
health authorities, and academic health science centers.
 Performing providers--Medicaid providers that are
responsible for performing a project in an RHP Plan.
Performing providers are primarily hospitals but also include
local mental health authorities, local health departments, and
physician practice plans affiliated with an academic health
science center.
26
RHP 4-year plan
 The Regional Health Partnership would be responsible for
developing a four-year coordinated regional health plan that:
– Includes regional health assessments of needs, resources and
potential improvements to serve as the basis for planning;
– Outlines projects and interventions that support delivery system
reforms tailored to the needs of the communities and populations
served by the hospitals
– Identifies the goals, rationale for projects, annual milestones,
associated metrics and expected results from the interventions;
– Incorporates private hospitals via RHP agreements that identify
their roles, contributions and associated outcome metrics.
 During the first year, regional entities develop and submit four-year
plans.
27
RHP Plans and CMS
Expectations
 Planning process that demonstrates regional
collaboration
 Projects selected address community needs
 Projects selected are the most transformative
for the region
 RHP Plan includes projects that tie the four
DSRIP categories together to demonstrate
outcomes
28
RHP Plan Template
 RHPs complete Plan Template in collaboration with
Performing Providers, Intergovernmental (IGT) Transfer
Entities, and other stakeholders
 The PFM Protocol and RHP Planning Protocol serve as
the basis for RHP Plan development and DSRIP funding
 Protocols and the RHP Plan Checklist are guides to
complete RHP Template
 RHP Plan electronic tool in development to meet PFM
requirements.
29
Stakeholder Engagement
 RHP Participant Engagement
 Information for Performing Providers including hospitals,
Community Mental Health Centers, Academic Health Science
Centers and Local Health Departments.
 Public Engagement
 Processes used to solicit public input into RHP Plan and public
review prior to plan submission, including county medical
societies
 Must include a description of public meetings and posting of
RHP Plans for input
 Plan for ongoing engagement with public stakeholders.
30
RHP Plans Process
 Projects and DSRIP payments are documented
in the RHP Plan in the region of the Performing
Provider
 Performing Provider submits project information
to Anchor
 Anchor compiles all projects for RHP Plan
 Electronic tool in development to assist RHPS
with meeting quantitative requirements
 Qualitative requirements included in RHP Plan
template
31
Today’s Presentation
I.
The Texas Budget
II.
Medicaid Managed Care Expansion
III.
Transformation Waiver
I.
Background
II.
Regional Partnerships
III.
Transition Payments
IV.
UC Tool
V.
Program Funding Protocol
VI. DSRIP
IV. Timeline
32
Transition Payments
 Fiscal Year 2012 Only
 Based on Historic Payments
 3 Quarters already Paid
 4th Quarter Payment
 Likely January/February 2013
 May Occur sooner if UC Tool not submitted
 Hospitals may choose to use UC Tool
33
Today’s Presentation
I.
The Texas Budget
II.
Medicaid Managed Care Expansion
III.
Transformation Waiver
I.
Background
II.
Regional Partnerships
III.
Transition Payments
IV.
UC Tool
V.
Program Funding Protocol
VI. DSRIP
IV. Timelines
V.
Conclusion
34
Uncompensated Care (UC) Pool
 UC pool payments include:
–Medicaid shortfall not covered by DSH;
–Costs of services to uninsured patients
not covered by DSH; and
–Medicaid and uninsured non-hospital UC
costs, including physician, clinic and
pharmacy
35
UC Tool or UC Protocol
 1st Data Posted Aug. 8
 Updated Version posted Aug. 17
 3rd version?
 Multiple records for same hospital still a problem
 Questions remain about hospital/physician
partnerships
 Deadline September 10
 THA submitted questions about the tool last
week
36
Costs to be included in the Hospital
UC Tool
 Physician costs related to direct patient care
services
 Mid‐level professional costs related to direct
patient care services
 Pharmacy costs related to the “Texas Vendor
Drug” program
 Excess “Medicaid DSH” costs not reimbursed
via the Medicaid DSH program
37
Physician UC Tool
 Physician costs related to direct patient care
services
 Non‐capital equipment and supplies costs
 Indirect costs via a provider‐specific indirect cost
Rate
 Costs related to Mid‐level professionals must
NOT be included in the UC Application
 Only organizations that received historical
physician UPL payments may complete
Physician Tool
38
UC Funding Issues
 UC is not allocated by regions, based on costs from the
UC tool
 If the statewide cap UC is exceeded, UC payments will
be reduced proportionately
 IGT may cross regions for UC and DSRIP based on
historical patient flow patterns. This will be addressed in
the program rules
39
Today’s Presentation
I.
The Texas Budget
II.
Medicaid Managed Care Expansion
III.
Transformation Waiver
I.
Background
II.
Regional Partnerships
III.
Transition Payments
IV.
UC Tool
V.
Program Funding Protocol
VI. DSRIP
IV. Timeline
40
Program Funding and Mechanics
Protocol
 Provides the Organization and Requirements
of the RHP Plans
 Sets out proposed allocation of DSRIP
and UC funding by RHP region
 Separates RHP regions into tiers and sets
minimum number of DSRIP projects for
each tier
41
Major Items
Under CMS Negotiation
 DSRIP requirements to be eligible for uncompensated
care (UC) payments
 Funding allocation methodologies
 Valuation of projects including a setting a maximum
value for a single project.
 Minimum DSRIP requirements by RHP and Performing
Providers
 Pass 2 methodology
 DSRIP project milestones and metrics
 Increased emphasis on DSRIP Category 3
42
CMS Expectations
 Planning process that demonstrates
regional collaboration
 Projects selected address community
needs
 Projects selected are the most
transformative for the region
 RHP plan includes projects that tie the
four categories together to demonstrate
outcomes
43
Administrative Issues
 Administrative cost claiming for Anchors will be
defined separately from the PFM Protocol
 Governance and resolution processes will be
determined at the local level
 CMS approval of all plans by March 1, 2013
 After RHP Plan submission, Performing
Providers may begin projects at their own risk if
it has not been approved by CMS
44
Funding Issues
 UC is not allocated by regions, based on costs from the
UC tool
 If the statewide cap UC is exceeded, UC payments will
be reduced proportionately
 IGT may cross regions for UC and DSRIP based on
historical patient flow patterns. This will be addressed in
the program rules
 THHSC will not request IGT until DSRIP performance
has been reported
 If the full IGT is not available, DSRIP is paid
proportionately based on achieved performance
45
UC and DSRIP Participation
 Hospitals receiving UC payments must report on a subset of DSRIP
Category 4 measures:
 Potentially Preventable Admissions (PPAs)
 Potentially Preventable Readmissions (PPRs)
 Potentially Preventable Complications (PPCs)
 Small and rural hospitals are exempted from DSRIP Category 4
reporting for UC
 Failure to report on the required measures by the last quarter of the
year will result in forfeiture of UC payments in that quarter
 Hospitals that only participate in UC shall not be eligible to receive
DSRIP funding for required Category 4 reporting
 UC hospitals must also participate in an annual RHP learning
collaborative
46
RHP Plans
 Projects and DSRIP payments are documented in the
RHP Plan of the Performing Provider
 A Performing Provider may only participate in the RHP
Plan where it is physically located
 RHP Plans must ensure that DSRIP payments for similar
projects are not duplicative
 RHP Plans must ensure that DSRIP payments do not
duplicate funding of federal initiatives funded by the
U.S. Department of Health & Human Services
 RHPs are strongly encouraged to adhere to the UC
and DSRIP benchmark allocation (50/50 in FY2016)
47
RHP Category 1 and 2
Minimum Number of Projects
 Currently there are 4 Tiers based on the
percent of population < 200% of the FPL
 HHSC to publish crosswalk of Region and
Tier
Tier
Category 1 & 2 Projects
Category 2
Tier 1
20
10
Tier 2
12
6
Tier 3
8
4
Tier 4
4
2
48
Performing Providers Minimum
Number of Projects
 For a DSRIP hospital:
 A minimum of 3 Category 3 interventions selected by the
hospital
– Small and rural hospitals are required a minimum of 1 Category 3
intervention
 Report on all Category 4 measures but optional for small and
rural hospitals
 Participate in one of the following
– Categories 1, 3, and 4
– Categories 2, 3, and 4
– Categories 1, 2, 3, and 4
 Non-hospital Performing Providers are required to implement a
minimum of 1 Category 3 intervention
49
Allocation to RHPs
 Each RHP shall be allocated DSRIP funds
based on low income population and Medicaid
burden using the following variables:
– Percent of state population with income below 200
percent FPL
– Percent of Texas Medicaid acute care payments in
fiscal year 2011
– Percent of Texas Medicaid supplemental payments in
fiscal year 2011
50
DY 1 DSRIP
 Anchoring Entities and Performing Providers that have a
current Medicaid provider identification number are
eligible for demonstration year (DY) 1 DSRIP for
submission of RHP Plans
– Anchoring Entity is allocated 20 percent
– Performing Providers are allocated the remaining
80 percent based on value of DSRIP Projects in
Categories 1-4 for DYs 2-5
51
DYs 2-5 DSRIP Allocation within RHPs
 75 percent allocation to DSH and former UPL
hospitals. Each individual hospital allocation is
based on:
– Fiscal year 2011 Medicaid acute care payments (FFS,
PCCM, MCO)
– Fiscal year 2011 Medicaid supplemental payments
(UPL)
– Uncompensated care (greater of fiscal year 2012
DSH Hospital Specific Limit or cost of charity care
in 2010 annual hospital survey)
52
DYs 2-5 DSRIP Allocation within RHPs
 25 percent allocation to non-hospital
providers
– 10 percent to community mental health
centers
– 10 percent to physician practices associated
with an academic health science center
– 5 percent to local health departments
53
Pass 1 Funding
 RHPs must meet the following:
 Minimum number of project requirements for the RHP
Tier level
 Project valuation parameters across the four DSRIP
Categories
 Each Performing Provider may not exceed its DSRIP
allocation
 Hospitals with DY 2 allocations of less than $2
million may collaborate
 Performing providers in Tiers 3 and 4 may
collaborate
54
Private Hospitals Pass 2 Funding
Broad hospital participation wherein RHPs shall
fund a minimum percent of the Pass 1 DSRIP
allocated to non-profit and private hospitals based
on Tier level
Tier
Private Hospitals
Tier 1
At least 30%
Tier 2
At least 30%
Tier 3
At least 15%
Tier 4
At least 5%
55
Pass 2 Funding
 If there are unused DSRIP allocation amounts
after the first pass, the RHP may redirect the
unused allocations to fund additional projects
– An individual hospital provider is not limited to
its DSRIP allocation in the second pass
– Physician practice groups not affiliated with
academic health science centers and new
hospitals may participate in DSRIP projects if
they have identified a source of non-federal
match
56
Pass 2 Allocations
 25 percent allocation of unused Pass 1 DSRIP funds to
“new” Performing Providers
– 15 percent to new hospitals
– 10 percent to physician practices not affiliated with an academic
health science center
 75 percent allocation to Performing Providers that have
Pass 1 projects
– Each Performing Provider is allocated a proportion based on the
funding of Pass 1 projects in DYs 2-5
– Within an RHP, Performing Providers may combine their
individual Pass 2 DSRIP allocations to fund a DSRIP project
57
Project Valuation
 Hospital Performing Providers must comply with the funding
distribution across Categories 1-4 for DYs 2-5
 A project may not be valued at more than $ 50 million in total over
DYs 2-5
 HHSC will review all project valuations for face validity
Category
DY 2
DY 3
DY 4
DY 5
1&2
< 86%
<76%
<71%
<66%
3
At least
10%
At least
15%
At least
20%
At least
25%
4
5%
10 – 15%
10 – 20%
10 – 25%
58
Plan Modifications
 Uncommitted DSRIP funding
– During DY2, if an RHP does not propose to use its uncommitted
DSRIP funds, HHSC will redistribute the available DSRIP to
RHPs with interest and funding to implement new projects in DY3
and met the broad participation requirement in Pass 1
 New DSRIP projects, new Performing Providers, and/or
new IGT Entities may be added in DY2 for
implementation in DY3
 Other plan modifications will be allowed for:
– Changes to milestones/metrics for existing projects
– Deletion of projects
59
PFM Electronic Project Templates
 1st Pass Template: Excel template for
Performing Providers to populate with 1st
Pass project information
 2nd Pass Template: Excel template for
Performing Providers to populate with 2nd
Pass project
 information
 RHP Anchor Model: Used to consolidate
regional project plans for submission to
CMS/HHSC
60
PFM Electronic Project Template
3 Excel Documents
61
Today’s Presentation
I.
The Texas Budget
II.
Medicaid Managed Care Expansion
III.
Transformation Waiver
I.
Background
II.
Regional Partnerships
III.
Transition Payments
IV.
UC Tool
V.
Program Funding Protocol
VI. DSRIP
IV. Timeline
62
DSRIP Categories
63
DSRIP Example Projects
TYPES OF CATEGORY 1 PROJECTS
TYPES OF CATEGORY 2 PROJECTS
•
•
•
•
•
•
•
•
Expand Primary Care Capacity
Increase Training of Primary Care
Workforce
Enhance Interpretation Services and
Culturally Competent Care
Enhance Urgent Medical Advice
Expand Behavioral Health Services
Expand Dental Services
CATEGORY 3 PROJECTS
•
•
•
•
•
•
Severe Sepsis Resuscitation and
Management
Potentially Preventable Admissions
Potentially Preventable Readmissions
Potentially Preventable Complications
Perinatal Outcomes
Diabetes Composite Measure
•
•
•
Expand or Enhance Medical Homes
Expand Chronic Care Management
Models
Redesign Primary Care
Establish/Expand a Patient Care
Navigation Program
Implement/Expand Care Transitions
Programs
CATEGORY 4 PROJECTS
(REPORTING)
•
•
•
•
•
Potentially Preventable Admissions
15-Day Readmissions
Potentially Preventable Complications
Patient-centered Healthcare
Emergency Department (cycle time)
64
Changes to DSRIP Category 3
 CMS proposed changing the approach to Category 3 as
follows:
– No longer focused on only hospitals, so other providers would be
included
– Rather than assessing statewide improvement in one area (e.g.,
sepsis), show performing provider outcomes for multiple areas
– No single, mandatory project, but more measures to be chosen
reflecting regional needs
– Rather than Category 3 containing specific projects, now
Category 3 will be outcome measures reflecting progress in
Categories 1 and 2
65
RHP Planning Protocol
Status
 Protocol under ongoing negotiation with CMS
 Reviewing projects on a rolling basis prioritizing high interest areas
 Revisions include increasing project detail with some additional
milestones and more refined metrics
 The Category 1 project to enhance coding and documentation for
quality data and the Category 2
 project to improve patient flow in the emergency department/rapid
medical evaluation have been removed
 Increased emphasis on Category 3, with a change to the common,
required sepsis measure
66
Project Selection Criteria
 Planning process that demonstrates regional collaboration
 Projects selected address community needs
 Projects selected are the most transformative for the region,
stressing integration and synergy among providers
 RHP Plan demonstrates projects that tie the four categories together
to demonstrate outcomes
 RHP Plans must ensure that DSRIP payments do not duplicate
funding of federal initiatives funded by the U.S. Department of
Health & Human Services
 Capital projects will be considered on a case-by-case basis and
evaluated in the context of the whole plan. Must demonstrate the
project is necessary to achieve long-term quality improvements
67
Category 1 and 2 Metrics & Milestones
 Metric – Quantitative or qualitative indicator of
progress toward achieving a milestone from a
baseline
 Milestone – An objective for DSRIP
performance comprised of one or more metrics
– Process milestones are objectives for completing a
process that is intended to assist in achieving an
outcome
– Improvement milestones are objectives to achieve
improved outcomes
68
Category 1 and 2
Metrics and Milestones
 Process Milestone example:
– Milestone: Write and disseminate a patient/family
experience strategic plan
– Metric: Submission of patient/family experience
strategic plan and documentation of the dissemination
of that plan throughout the organization
 Improvement Milestone example:
– Milestone: Improve patient satisfaction/ experience
scores
– Metric: X percent improvement over baseline patient
satisfaction scores captured by HCAHPS
69
Today’s Presentation
I.
The Texas Budget
II.
Medicaid Managed Care Expansion
III.
Transformation Waiver
I.
Background
II.
Regional Partnerships
III.
Transition Payments
IV.
UC Tool
V.
Program Funding Protocol
VI. DSRIP
IV. Timeline
70
Major Items Under CMS Negotiation
 DSRIP requirements to be eligible for uncompensated
care (UC) payments
 Funding allocation methodologies
 Valuation of projects including a setting a maximum
value for a single project
 Minimum DSRIP requirements by RHP and Performing
Providers
 Pass 2 methodology
 DSRIP project milestones and metrics
 Increased emphasis on DSRIP Category 3
71
Outstanding Issues
 Timing – can HHSC complete its tasks?
 UC payments were originally scheduled to begin 10/31
but have been pushed back to at least December
 HHSC allotting only one month to negotiate complicated
protocols with CMS
 Rule-making
 Year-end payment reconciliation
 Contingency Plans
72
Timeline
 October 31, 2012 – Final RHP plans due to CMS
 HHSC anticipates 30 day state review for each RHP
Plan
 CMS will not begin formal review until HHSC completes
quality check of RHP Plan
 Program rules published in Texas Register August 24,
2012 for 30 day comment period
 Rules adopted by October 31, 2012
 DY 1 DSRIP payments for RHP Plan submission within
70 days of approval of the plan
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Waiver Communications
 Find updated materials and outreach details:
 http://www.hhsc.state.tx.us/1115-waiver.shtml
 Submit all questions to:
[email protected].
us
 http://www.tha.org/HealthCareProvid
ers/Issues/FinanceandReimburse098F/Medic
aidBBBFWaiver/index.asp
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Questions?
Michelle Apodaca, JD
Vice President
512/465-1506
[email protected]
John Berta
Senior Policy Analyst
512/465-1556
[email protected]
www.tha.org