Hospital/UHRIP DPP: HHSC has created a workgroup that has been reviewing and considering a redesign of the existing UHRIP (uniform hospital rate increase program) directed payment program. HHSC has had some discussions with CMS as they recently finalized the terms for the current program year for UHRIP. What they know from CMS is that it may be possible to expand the UHRIP program but CMS would expect to see a quality component added to the program/tied to the funding. HHSC Waiver Operations and HHSC Provider Finance have been working with/facilitating subgroups to look at various models, directed payment program federal rules (including limitations and requirements), as well as quality components and considerations. HHSC is also working with a contractor on financial models.
Physician DPP: HHSC created a workgroup to evaluate possible directed payment program opportunities for physician groups. One consideration discussed is revising the existing NAIP (network access improvement program) DPP, which is currently a pass-through program for academic health science centers in partnership with managed care organizations. Preliminary considerations include adding a quality component tied to NAIP funding. HHSC is considering three main practice types: physician practices associated with health-related institutions (aligns with DSRIP practices), physician groups contracted with hospitals that receive IME add-ons (indirect medical education), and possibly community private physician practices.
Rural: A rural workgroup will evaluate possible directed payment programs that would be targeted to rural health clinics. Goal would be to incentivize and continue improving primary care in rural communities. There are several RHCs who have been subcontracted partners in DSRIP that could possibly become eligible primary care providers under a DPP program. HHSC has started working with RHCs and other rural health entities to develop what this would look like, evaluate a lot of the existing rural health bundle measures, and discuss payment options for that.
CMHCs: A CMHC workgroup will be led by HHSC to also evaluate potential directed payment programs for DY11. The goal here would be to continue the significant work and behavioral health services in the DSRIP program; continuing to improve on that and to incentivize CMHCs to become certified community behavioral health center (CCBHC) models if not already doing that. A lot of the measures required as part of the CCBHC model align with what is done in DSRIP.
LHDs: With regard to LHDs, HHSC plans a workgroup to evaluate three possible program options designed to complement each other. The possible options HHSC is looking to evaluate are: (1) whether or not LHDs could participate in the UC (uncompensated care) program; (2) an LHD directed payment program similar to the physicians program – tied to Medicaid utilization that includes a quality component; and (3) some type of cost-reimbursement methodology for services provided by LHDs to the Medicaid public (e.g., similar to school health and related services programs).
Note on LIU Population: HHSC understands that directed payment programs of any type are run through managed care organizations and tied to utilization rates. HHSC indicated they continue to have internal discussions with leadership regarding the LIU population. However, they are not at a point in which they have any information to share specific to that issue.