Texas Hospital Association

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 Dec. 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.


5/21/14HHSC waiver presentation to the May 14, 2014 House County Affairs committee interim hearing.

THOT waiver presentation to the May 14, 2014 House County Affairs committee interim hearing. 

Revised timeline as of 3/21/14.


2/17/14Key Waiver dates for 2014.


11/4/13 – Updated key waiver dates are available.


10/3/13THHSC presentation from the Executive Waiver Advisory Committee.


9/9/13 – THHSC posts new key Waiver dates.


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.


4/24/13Summaries 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 (image).


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.


12/11/12Executive Waiver Advisory Committee presentation by THHSC, and THA Notes image  (members only).

12/6/12 – THHSC's Immediate Guidance to RHPs.


Final Waiver Documents (as of 11/12/12)

Uncompensated Care

Texas Hospital UC Tool Frequently Asked Questions

Forms to be completed by Eligible UC/DSRIP Providers:

*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:

*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

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.

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.

Recent THHSC Presentations


Further Reading:

 


Subsidiaries and Affiliates

HealthSHARE

Texas Hospital Insurance Exchange

Texas Hospital Association Foundation

Texas Healthcare Trustees

HOSPAC

According to Texas Government Code 305.027, portions of this material may be considered “legislative advertising.” Authorization for its publication is made by John Hawkins, Texas Hospital Association, 1108 Lavaca, Suite 700, Austin, Texas, 78701-2180.