Welcome to RHP 9 – Transforming Healthcare Now

Waiver Information

  • Five-year demonstration waiver that began on September 1, 2011
  • Aligns with the Triple Aim of the Centers for Medicare and Medicaid Services (CMS): Improve the experience of care, Improve the health of populations, and Reduce the per capita costs of healthcare without compromising quality.
  • Creation of Regional Healthcare Partnerships (RHP) that support coordinated, efficient delivery of quality care, and a plan for system transformation that is driven by the needs of the community.
  • Provides incentive payments for quality improvement and healthcare delivery system reform

Quick Facts on RHP 9:

  • 3 Counties: Dallas, Denton, & Kaufman
  • 2,530 square miles
  • Population of 3.1 million
  • 40% are low income
  • 25 providers participating in Delivery System Reform Incentive Payment (DSRIP) projects
  • Needs assessment: Gaps in access, behavioral health, and overall care coordination.
  • 129 DSRIP projects
    • 46 Infrastructure Development projects (Category 1)
    • 83 Program Innovation and Redesign projects (Category 3)
    • 200 Plus Outcome Measures (Category 3)

Friday, August 26, 2016: 

HHSC will begin providing approval of requested MLIU reporting exceptions, required QPI/MLIU changes, and submitted next steps or request additional information.

Week of August 22, 2016: 

Feedback from HHSC on Cat 3 Interim corrections (submitted on 8/11/16) and PFPM Baseline Templates (submitted 8/15/16).  

Friday, August 26, 2016: 

Public hearing for the 2nd set of DSRIP rules for 2016.  The hearing will be held in the Brown Heatly Building, Public Hearing Room, located at 4900 N. Lamar Blvd. in Austin.  It will be webcast.

Tuesday, August 30, 2016: HHSC Statewide Learning Collaborative; Austin 
Tuesday, August 30 and Wednesday, August 31, 2016: HHSC Statewide Learning Collaborative; Austin 
August 2016: 

HHSC is working with two existing contractors that have the subject matter expertise to complete the study. Health Management Associates (HMA) will complete the study, and Deloitte will be responsible for the actuarial portion of the project.

Wednesday, August 31, 2016: Due date for CMS required UC study.  HHSC is working with two existing contractors that have the subject matter expertise to complete the study. Health Management Associates (HMA) will complete the study, and Deloitte will be responsible for the actuarial portion of the project.
Wednesday, September 7, 2016: 

Providers submit responses to Anchor for Cat 3 alternate achievement requests and additional information requested from HHSC on the DY6 Participation Form.  

Friday, September 9, 2016: 

Anchors submit responses to HHSC requests for additional information, and Category 3 stretch activity selections and alternate achievement requests.   

Tuesday, September 27, 2016: 

Providers submit Cat 3 Stretch Activity selections to the Anchor. 

Wednesday, September 28, 2016: Learning Collaborative Session; THR University, 8194 Fogelson Lane, Dallas, TX 75231 - Room 112; 1pm to 4pm 
September 2016: Providers must re-enroll in Texas Medicaid to remain active providers for Texas Medicaid and to continue participation in DSRIP
Friday, September 30, 2016: Anchors submit Cat 3 Stretch Activity selections.
Friday, September 30, 2016: 

HHSC will approve or deny the additional information submitted in response to HHSC comments.

Saturday, October 1, 2016: 

Protocol information on Replacement Projects that would start in DY 7; Protocols for funds not dedicated to projects (leftover funds)

Saturday, October 1, 2016: Approved combined projects are effective (pending CMS approval of the transition year). 
Saturday, October 1, 2016: Approved DY6 projects are effective.
Saturday, October 30, 2016: DY5 DSRIP Reporting due

Thursday, December 15, 2016: RHP9 Annual Report and Regional Learning Collaborative Plan for DY6a is due to HHSC
Sunday, January 1, 2017: Draft Protocols for continuing projects to finalize by Spring 2017
Tuesday, January 3, 2017: IGT due for October DY5 reporting DSRIP payments
Friday, January 13, 2017: October reporting DY5 DSRIP payments for transferring hospitals and top 14 IGT Entities
Tuesday, January 31, 2017: DY5 for remaining providers and any DY4
Wednesday, February 22 and Thursday, February 23, 2017: 

RHP 9 & 10 Collaborative Connections: Impacting Care Learning Collaborative.  Register at:  RHP 9 & 10 Learning Collaborative Event

June 2017: Regional Community Needs Assessment due.  


Making a Difference

Category 3 Interim Corrections and PFPM Baselines
  •          HHSC has completed reviews of Category 3 Interim corrections that were submitted to HHSC by August 11th.  HHSC will be notifying providers of approval or any needed follow up this week.
  •          HHSC has also completed reviews of PFPM Baseline templates that were submitted August 15th. HHSC will be notifying providers of approval or any needed follow up this week.
DY6 DSRIP Rule Set #2
  •     Just a reminder that the public comment period for the second set of DY6 DSRIP rules, which closely mirror the DY6 Program Funding and Mechanics (PFM) protocol language, ends August 29, 2016.   These rules were published as proposed in the July 29, 2016, issue of the Texas Register, and are available here - http://www.sos.state.tx.us/texreg/pdf/backview/0729/0729prop.pdf
  •        Please note that the public hearing date listed in the initial Texas Register posting is inaccurate.  The public hearing on these rules will be held on August 26, 2016, at 9:00 AM at HHSC, Brown Heatly Building, Public Hearing Room, 4900 N. Lamar Blvd., Austin, TX.   The public hearing will be webcast.  
2016 Statewide Learning Collaborative
  •        Attached is the final agenda.
  •        HHSC has arranged for the Statewide Learning Collaborative Summit to be available for viewing on-line, in real time, in order to allow all interested individuals to watch the proceedings.  To access the Summit via webcast on August 30th and/or 31st , please click on the Summit Webcast link: https://player2.streamspot.com/?playerId=92a4a38d. The webcast will only stream the sessions that are occurring in the Grand Ballroom.  A test stream will be available on August 22 - 24 each day between the hours of 8:00AM and 10:00PM at the same link (https://player2.streamspot.com/?playerId=92a4a38d) in order for viewers to troubleshoot any firewall issues prior to the Summit.  If issues are encountered during the test stream, we recommend facilities wanting to watch the Summit open up the ability to offer streaming through their firewall and test again to make sure it is working. When you access this site during the test period or the Summit hours, please press play to begin watching on-going sessions. If at any time a participant leaves the webcast and returns later, you will need to click on the same link and press play to re-join. During the webcast, participants may submit questions through an online chat function. Questions will be answered after the Summit concludes. 
Executive Waiver Committee
  • No longer term extension talks yet with CMS.
  • HHSC is reviewing the summer templates.  Final approval/denial by September 30th
  • There may be some QPI that are outliers and will be adjusted for DY6. But the majority will not be adjusted.
  • Jami Snyder is the new Chief Deputy Director for Texas Medicaid/CHIP.  http://www.hhsc.state.tx.us/news/release/2016/072216.shtml
  • HHSC has submitted a draft of the Uncompensated Care (UC) Costs report that is required as part of the waiver extension. Final report is due August 31.  HMA prepared the attached report.
    • 98% of all Medicaid/low-income uninsured hospital costs in Texas are included. 
    • $8.9 billion in UC prior to supplemental payments
    • $2.9 billion total UC shortfall
      • However the $1.3 billion DSRIP funding to hospitals was included as a supplemental payment.    
      • CMS required that the report must include the impact of DSRIP funding on the uninsured and Medicaid shortfall. 
      • HMA argues that inclusion of DSRIP is inappropriate and distorts the Medicaid shortfall as the STC states that “DSRIP payments are not direct reimbursement for expenditures of payments for services”, and as an incentive program, payments are not applicable to a hospital’s hospital specific limit for DSH or UC pool purposes.
    • Final UC report will include an analysis on the impact of Medicaid expansion on TX hospital’s UC of caring for the LIU. 


Great news – all NMIs for DY5 R1 were approved.  Payments for the NMIs will be included in the January 2017 payment cycle. HHSC Rate Analysis will be sending out the IGT due amounts near the end of December using FMAP of 56.18 for these metrics, as well as those approved during the October DY5 reporting review period. The IGT due date for these metrics will be 1/3/17.

SLC – MCO Alignment
  • One of the SLC panels on August 30th will be a discussion on Value Based Contracting: Perspectives from National, State, MCO and Provider Levels. 
  • In order to help the panelists prepare information most helpful to DSRIP providers, HHSC is requesting feedback about challenges and opportunities in the effort to align with MCOs. 
  • Please see the questions below and send your response to the anchor by next Thursday, August 4th

o   What barriers are you facing with the effort to align with MCOs?

o   What types of tools/assistance/investment  do you think would be helpful in accelerating this effort?  Consider solutions from the following angles:

o   From HHSC

§  Short term

§  Long Term

o   From MCOs

§  Short term

§  Long Term

o   From Anchors or DSRIP providers

§  Short term

§  Long Term

o   Where are the biggest opportunities in RHP 9 for success in aligning with MCOs?