Waiver Renewal

The Texas 1115 Medicaid Transformation Waiver is a five year waiver expiring on September 30, 2016. The waiver's terms and conditions require HHSC to submit a renewal request to the Centers for Medicaid and Medicare Services (CMS) no later than September 30, 2015 to request to extend/renew the waiver. HHSC held stakeholder meetings around the state regarding the renewal request during July 2015. A summary of all comments from the public hearings (including the webinar) was posted on the HHSC Waiver Renewal webpage. Texas submitted the 1115 Transformation Waiver Extension Application to CMS. Please visit the Waiver Renewal page of HHSC Waiver website for more information.

Waiver Renewal Planning

HHSC held the first public meeting on July 13, 2015 in Houston, TX to receive comments on the 1115 Waiver Extension Application Draft, attachments (A, B, C, D, E) and Public Notice that were posted on the HHSC Waiver Renewal webpage. A copy of the presentation for Waiver Extension public meetings (PDF) was also made available. The public comment period for the 1115 Waiver Extension draft closed on August 5, 2015. A summary of all comments from the public hearings (including the webinar) was posted on the HHSC Waiver Renewal page. Finally, Texas submitted the 1115 Transformation Waiver Extension Application to CMS by September 30, 2015. The submitted cover letter, application, and interim evaluation report are available to the public.

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: 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 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 CNA 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.

Transformational Impact Summaries

HHSC requested that providers review their active DSRIP projects to determine which have evidence of early successes in transforming care delivery and improving patient outcomes. For those successful projects, additional information was requested about the project, beyond what was captured in the online reporting system, using the Transformational Impact Summary Template.

This information would be used to: describe best practices by project area, inform Waiver renewal negotiations with CMS (including the RHP Planning Protocol), develop content for the 2015 Statewide Learning Collaborative, and identify opportunities to better evaluate DSRIP projects in next phases of the Waiver. This information would NOT be used to: conduct a formal peer evaluation process or determine which projects are eligible for continuation in next phases of the Waiver.

Providers had the opportunity to complete one Transformational Impact Summary Template for each project that has evidence of early success and submit them to the Anchor Office at bjguyton@utmb.edu by Friday, May 29th, 2015 by COB. Early successes could include positive data, cost savings, managed care alignment, improvements in Medicaid population outcomes, collaborations, and other indicators of success outside of or in concert with metric and milestone achievement.   The RHP 2 Anchor Office hosted two (2) informational calls/webinars to answer questions regarding this HHSC request on Tuesday May 19th from 3:00-4:00 PM and Thursday May 21st from 9:00-10:00 AM. These impact assessments have been very important in the ongoing Waiver renewal/extension discussions.

The Anchor Office obtained templates from performing providers and submitted them to HHSC to be distributed to the Clinical Champions workgroup.  This workgroup has been reviewing submitted projects to assess the impact of the project across several domains: impact to patients and target populations, transformation of care delivery, strength of project design, benefit to the safety net system and potential for project sustainability.

Based on the findings of this process, HHSC and the Clinical Champions shared with all providers best practices identified by project type. HHSC used this information to identify provider panel presenters and posters for the Statewide Learning Collaborative that was held on August 27th and 28th, 2015.   Providers can use this information to guide program improvements.

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