Region 2: Texas Medicaid 1115 Waiver

Kudos 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

February 1, 2016–All requests for proposing project combinations must be sent to the HHSC mailbox by COB on Monday, February 1st using the subject line Combination Template, and a recommended file naming convention of RHP02_TPI_Project_Combination_Template. More information is available here

February 4, 2016–Last date to transfer funds into TexNet for UC. More information is available here

February 12, 2016–If providers are proposing to correct previously reported Category 3 metrics, all proposed corrections must be sent to HHSC mailbox by COB on Friday, February 12th. More information is available here

February 16, 2016–HHSC has a survey on the Transition Year (DY6) Proposal that is scheduled to close on Tuesday, February 16, 2016. More information is available here

April 1, 2016–April DY5 reporting window opens

April 30, 2016, 11:59 PM–April DY5 reporting window closes

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. The survey for stakeholder feedback on the DSRIP protocol level proposals is still open and posted on the HHSC Waiver Renewal page. The survey link is HHSC will continue to keep it open in its current form until HHSC has any updates to make based on conversations with CMS, at which point HHSC will update it for additional stakeholder feedback on new items or changes. Attached is information on the transition year (DY 6) proposal that has been communicated to CMS. HHSC anticipates getting some initial feedback from CMS on the transition year proposal in December 2015. 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. For DSRIP, CMS asked Texas to explore further financial integration of DSRIP into Medicaid managed care (i.e., running DSRIP payments through the managed care plans, similar to NAIP). HHSC explained at a high level the operational complexities of this (300 varying providers) and also that one of the DSRIP target populations is low-income uninsured. CMS understands these considerations, and asked HHSC to explore potential options to move in this direction. HHSC is analyzing internally and will share more with stakeholders.

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 will be included in the Transformation Extension Menu (TEM) project options for replacement projects, if approved. The next iteration of the menu will include proposed best practice models for the designated project options. The next iteration will be shared with stakeholders for feedback in January 2016. The feedback will inform the proposed TEM menu proposed to CMS.

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