Region 2: Texas Medicaid 1115 Waiver

Congratulations to the work regional performing providers have done to meet DSRIP project metrics and milestones which were designed to transform healthcare delivery in Texas as well as optimize health system performance through three dimensions, which we call the “Triple Aim:” 1) improving the patient experience of care, including quality and satisfaction; 2) improving the health of populations; and, 3) reducing the per capita cost of health care. Please take a few minutes to stop and celebrate your accomplishments, and use these significant results to motivate you and your colleagues to push forward to make even more substantial impact during the remainder of the current waiver period.

Important Dates

May 4, 2016, 11:59 PM–April DY5 reporting window closes

May 13, 2016–DSH Qualification results will be sent to providers

May 20, 2016, 5:00pm–Due date for IGT feedback on their affiliated providers’ April reported progress. (Optional)

May 27, 2016, 5:00pm–Due date for DSRIP IGT changes

May 27, 2016–DSH IGT notification date

June 2016–Expected Category 3 Interim Correction Period #2

June 2016–All DY5 DSH providers paid

June 1, 2016–Effective date of Transition Year Rule Packet #1

June 8, 2016–HHSC will complete the initial reporting review and distribute reporting results

June 27, 2016–Proposed Transition Year Rule Packet #2 submitted to the Texas Register

July 1, 2016–IGT settlement date for April reporting DSRIP payments

July 6, 2016, 11:59pm–Due date for April NMI Reporting submissions

July 8, 2016–Proposed Transition Year Rule Packet #2 published in the Texas Register

July 15, 2016–April reporting DY5 DSRIP payments processed for transferring hospitals and top 14 IGT Entities

July 29, 2016–April reporting DY4 DSRIP payments processed for all providers and DY5 DSRIP payments processed for remaining providers that were not paid on July 15, 2016

August 5, 2016–HHSC will complete NMI Reporting Review and distribute reporting results

August 8, 2016–Public comment period for Transition Year Rule Packet #2 ends

August 8, 2016–Deadline to register for the Texas 1115 Healthcare Transformation Waiver Statewide Learning Collaborative (SLC) Summit. More information is available here

August 30-31, 2016–2016 Statewide Learning Collaborative Summit

September 9, 2016–Adopted Transition Year Rule Packet #2 submitted to the Texas Register

September 23, 2016–Adopted Transition Year Rule Packet #2 published in the Texas Register

September 30, 2016–Effective date of Transition Year Rule Packet #2

September 2016–All DY5 UC providers paid

Important Announcements

Waiver Renewal Planning

The Clinical Champions workgroup, in coordination with HHSC leadership and staff, has developed a process for DSRIP performing providers to demonstrate the benefits and early successes of some of the strongest DSRIP projects through peer assessment reviews.

HHSC posted the 1115 Waiver Extension Application Draft, attachments and Public Notice on the Waiver Renewal page of HHSC Waiver website. HHSC also took comments on this draft from July 6, 2015 to August 5, 2015. A summary of all comments from the public hearings (including the webinar) has been posted on the HHSC Waiver Renewal page.

HHSC will continue to work with stakeholders on detailed programmatic changes to the protocols not addressed in the waiver extension draft. More information on protocol-level proposals were provided at the Statewide Learning Collaborative Summit on August 27-28, 2015. During the DSRIP Extension Webinar on 9/30/2015, HHSC discussed planning for transition and working with CMS on the protocols. The webinar presentation is available here. HHSC has been developing two DSRIP transition year (demonstration year [DY] 6) rule packets. Attached is information on the transition year (DY 6) proposal that has been communicated to CMS.

*New* CMS officially approved a 15-month extension of the 1115 Waiver for Texas on May 1, 2016. Negotiations on a longer-term agreement will continue. More information is available here.

CMS has also communicated two directions for future DSRIP (for all states) which are sustainability--DSRIP should not be considered an ongoing funding source--and Implementation of Alternative Payment Methodologies (APM)--similar to Value-based purchasing. Here is a link with more information on APM: https://hcp-lan.org/groups/apm-fpt/apm-framework/. CMS has requested an initial high-level work plan for integration into managed care, which HHSC is developing and will share with stakeholders before formal submission to CMS. The work plan will specify that a subset of projects will be identified for integration into managed care that could be either continuing or replacement projects.

HHSC is moving forward with development of the proposed Performance Bonus Pool that is planned to replace the current Category 4, in terms of the potential performance measures as well as the supporting policies. HHSC has requested feedback on the proposed measures and has not received much input on the set of measures. HHSC encourages providers to review the proposed measure list (http://www.hhsc.state.tx.us/1115-docs/012616/Performance-Bonus-Pool.pdf) and send feedback on additional claims-based measures that should be considered and measures currently listed that providers recommend should not be included. Feedback can be provided directly to the HHSC Waiver mailbox. In absence of any additional feedback, HHSC will plan to move forward with performance analysis of the currently proposed measures to help determine which of those measures to include in the menu. HHSC anticipates having additional information available this summer regarding the measures, rationale for selection, financial policies and requirements for regional selection. HHSC also continues to receive questions about the Community Needs Assessment (CNA) redo/update that will be required prior to a region submitting its performance bonus pool measure selections. While HHSC does not plan to prescribe the CNA process for the regions, HHSC will develop a template for Anchors to report their RHP's CNA process.

For UC, CMS indicated that Texas' ask is more than what CMS thinks is warranted. HHSC will do the required independent analysis, but asked for an extension beyond the CMS requested submission date of May 31, 2016. Additional information that will be requested of providers for the waiver extension will be Summer 2016, when providers will be asked whether they plan to continue existing projects or propose replacement projects. HHSC is working on a "template" and tentatively plans for providers to submit in July 2016, pending CMS feedback.

Based largely on the Transformational Impact Summaries, HHSC and the Clinical Champions are working together to describe effective models for care delivery. HHSC will use this information around best and promising practices to support protocol development in the renewal period as well as offering guidance to providers on opportunities to make improvements in continuing DSRIP projects. These best practices were included in the Transformation Extension Menu (TEM) project options for replacement projects, if approved. Stakeholder feedback informed the proposed TEM menu proposed to CMS.


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