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

December 2, 2016, 5:00 pm–Deadline for changes in IGT entities or proportion of IGT among entities

December 9, 2016-HHSC and CMS will complete their review and approval of October reports or request additional information (referred to as NMI) regarding the data reported

January 3, 2017–IGT due for October reporting DSRIP payments and Monitoring IGT

January 9, 2017–HHSC will send the applications to providers. HHSC Rate Analysis must receive a completed application no later than 30 calendar days from this date unless an extension is requested and granted. HHSC Rate Analysis will extend this deadline provided that HHSC receives a written request for the extension to the UC tools mailbox

January 10, 2017–2017 DSH/UC Webinar for completing the application and methodology changes for 2017 DSH and DY 6 UC. Providers may register for the webinar here

January 13, 2017–October reporting DY5 DSRIP payments processed for transferring hospitals and top 14 IGT entities

January 16, 2017, 11:59 pm–Due date for providers to submit responses to HHSC requests for additional information on October reported milestone/metric achievement and incomplete semi-annual progress reports

January 27, 2017–DY 6 UC Advance Payment IGT Notification

January 31, 2017–October reporting DY4 DSRIP payments processed for all providers and DY5 DSRIP payments processed for remaining providers that were not paid on January 13, 2017; Note that there are separate transactions for each payment for each DY

February 3, 2017–Deadline for providers to request a 15 day extension to submit their application. Extensions are only granted for application submissions and not appeal submissions

February 10, 2017–Deadline for Medicaid data appeal submissions to TMHP/HHSC, Deadline for providers to request a 15 day extension to submit their application. Extensions are only granted for application submissions and not appeal submissions, Application due date for providers who do not request extensions

February 24, 2017–HHSC and CMS will approve or deny the additional information submitted in response to HHSC's NMI requests from October reporting

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.

*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. On June 23, 2016, CMS sent to HHSC a letter approving the proposed DY6 PFM protocol language. The only substantive change that HHSC made to the version of the DY6 PFM protocol language that HHSC sent to anchors for feedback on June 8, 2016, is related to Category 3. For Category 3 outcomes designated as P4R with an associated stretch activity in DY5, HHSC revised the language to give providers a second option. Providers may either: 1) maintain the Category 3 outcome designated as P4R from DY5 and select a new stretch activity; or 2) select a population focused priority measure (PFPM) that is P4P. Under Option 1, 50% of the Category 3 outcome's value is P4R of the Category 3 outcome, and 50% is for completion of the stretch activity. Under Option 2, 100% of the Category 3 outcome's value is P4P of the newly selected PFPM. 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: 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 also continues to receive questions about the Community Needs Assessment (CNA) redo/update that will be required. 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. The PFM states that the updated regional community needs assessment will be due in June 2017.

For UC, CMS indicated that Texas' ask is more than what CMS thinks is warranted. On August 31, 2016, HHSC submitted to CMS the Uncompensated Care Study report required by the standard terms and conditions of the 15-month 1115 Waiver Extension.

Based largely on the Transformational Impact Summaries, HHSC and the Clinical Champions are working together to describe effective models for care delivery. HHSC uses 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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