Medicaid 1115 Waiver - Texas Health Care Transformation and Quality Improvement Program
The Texas Health and Human Services Commission filed an application for a waiver of certain federal Medicaid requirements under Section 1115 of the Social Security Act on July 13, 2011. The Centers for Medicare & Medicaid Services approved THHSC’s application on December 12, 2011.
The waiver primarily does two things: (1) it expands Medicaid managed care to the entire state; and (2) it replaces the upper payment limit program with two new pools of funding, the uncompensated care pool, and the delivery system reform incentive payment pool. The UC pool will reimburse hospitals for the cost of care for Medicaid and uninsured patients for which the hospital does not receive payment. The DSRIP pool will provide payments to hospitals and other providers upon their achieving certain goals that are intended to improve the quality and lower the cost of care. Texas has the potential to receive up to $29 billion over the 5 years of the waiver, which is more than the $14 billion in funds available under the UPL program.
4/29/13 – On Tuesday, May 7, at 2 p.m. THHSC will hold a Medicaid Waiver Technical Assistance Webinar to review changes to the Program Funding and Mechanics Protocol and discuss how RHP anchors and DSRIP providers should address federal Initial Review Findings for RHP Plans.
4/24/13 – Summaries of Proposed Delivery System Reform Incentive Payment (DSRIP) Projects Based on Regional Healthcare Partnership Plan Submissions for Federal Review – Subject to Change
4/1/13 – THHSC 3/22/13 anchor call notes are available here.
3/28/13 – Notes from the 3/22/13 anchor call for THA members are here (
).
3/12/13 – Find the RHP plans submitted by THHSC to CMS here.
03/01/13 – THHSC releases a updated DSRIP project list.
03/01/13 – THHSC is posting RHP plans submitted to CMS here: http://www.hhsc.state.tx.us/1115-RHP-Plans.shtml
01/31/13 – THHSC releases a preliminary DSRIP project list and provides technical guidance on how to withdraw collaborative projects, as well as notes from the last anchor call.
01/18/13 – THHSC issues feedback to RHPs on DSRIP project valuation.
01/11/13 – Final RHP Plans – All of the final RHP plans submitted to THHSC can be located online. Find them here.
12/11/12 – Executive Waiver Advisory Committee presentation by THHSC, and THA Notes (members only).
12/6/12 – THHSC's Immediate Guidance to RHPs.
Final Waiver Documents (as of 11/12/12)
- Information regarding the UC Tools
- Access the UC Tool (due by 10:00 a.m. on Friday, Nov. 9)
- Training Information for the UC Tool
- TXHUC Checklist for completion of UC Tool
- TXPUC Checklist for completion of UC Tool
Texas Hospital UC Tool Frequently Asked Questions
Forms to be completed by Eligible UC/DSRIP Providers:
- Certification of Hospital Participation
- Certification of Physicians Group Participation
- AP - 152 (application for Texas Identification Number) *
- 74 - 176 (Direct Deposit Authorization/Advance Payment Notification) *
- 74 - 193 Advance Payment Notification Form (for hospitals who already have Direct Deposit)
*Entity Name, Address, Phone Number, etc. must match on both the Application for Texas Identification Number and the Direct Deposit Authorization/Advance Payment forms.
Forms to be completed by Governmental Entity:
- Certification of Governmental Entity Participation
- Certification of Governmental Entity Participation (for Physician Affiliates)
- AP - 152 (Application for Texas Identification Number) *
- 74 - 176 (Direct Deposit Authorization/Advance Payment Notification) *
- 89 - 103 TexNet Enrollment Form
*Entity Name, Address, Phone Number, etc. must match on both the Application for Texas Identification Number and the Direct Deposit Authorization/Advance Payment forms
New Affiliations or Providers Checklist for Packet Submission
These checklists identify the documents that need to be submitted by private hospitals submitting TXHUC forms and physicians submitting TXPUC forms.
Delivery System Reform Incentive Payment Pool
- Frequently Asked Questions (10/25/12)
- RHP Plan Anchor Checklist (10/25/12)
- Final Regional Healthcare Partnership Plan Template (Updated 10/12/12)
- RHP Plan Template Companion Document (Updated 10/25/12)
- RHP Planning Protocol Introduction (10/1/12)
- RHP Planning Protocol Category 1 (10/1/12)
- RHP Planning Protocol Category 2 (10/1/12)
- RHP Planning Protocol Category 3 (10/1/12)
- RHP Planning Protocol Category 4 (10/1/12)
- RHP Planning Protocol Appendix (10/1/12)
- Pre-Populated Workbooks for Pass 1 DSRIP funding
- Pass 1 Workbook Instructions
- Other Pass 1 Workbooks for Performing Providers (ZIP, 18MB) (10/05/12)
- List of Hospital Pass 1 DSRIP Allocations (10/12/12)
- List of TPIs by Performing Provider
- List of Affiliation Numbers (10/05/12)
- Required Pass 1 Funding to Private Hospitals to be Eligible for Pass 2 Funding
- Anchor Workbook Instructions (10/25/12)
- Pass 2 Workbook (11/12/12)
- Pass 2 Workbook Instructions (10/10/12)
- Pass 3 Workbook (11/12/12)
- Pass 3 Workbook Instructions (10/10/12)
- Category 4 Guidance (11/12/12)
- Sample Project (10/15/12)
- Program and Funding Mechanics Protocol
Rules
1115 Waiver Rules: The final/adopted waiver program rules are available for viewing on the Texas Register website. The preambles for each of the rules can be viewed by clicking on the “preamble” tab on the top left side of each posting.
- 1 TAC §354.1601 – Introduction
- 1 TAC §354.1602 – Definitions
- 1 TAC §354.1611 – Organization
- 1 TAC §354.1612 – Anchors
- 1 TAC §354.1613 – Participants
- 1 TAC §354.1621 – RHP Plan
- 1 TAC §354.1622 – RHP Plan Assessment
- 1 TAC §354.1631 – DSRIP Categories
- 1 TAC §354.1632 – DSRIP Requirements for Regional Healthcare Partnerships
- 1 TAC §354.1633 – DSRIP Requirements for Performers
- 1 TAC §354.1634 – Waiver Pool Allocation and Valuation
Hospital, Physician Services and Hospital-Specific Limit Rules: The final hospital, physician services and hospital-specific limit rules as published in the June 22 edition of the Texas Register are available. The preambles for each of the rules can be viewed by clicking on the “preamble” tab on the top left side of each posting.
- 1 TAC §355.8066 – Regarding Hospital Specific Limit Methodology.
- 1 TAC §355.8201 – Regarding Waiver Payments to Hospitals.
- 1 TAC §355.8202 – Regarding Waiver Payments for Physician Services
Recent THHSC Presentations
- Public Health Committee Presentation (10/17/12)
- RHP Plan Template Webinar Presentation (9/25/12)
Further Reading:
- Resources for Medicaid 1115 Waiver
- Medicaid 1115 Waiver Timeline
- Regional Healthcare Partnerships
- Uncompensated Care
- Delivery System Reform Incentive Payments
- Members Only Information
