Welcome to RHP 9 – Transforming Healthcare Now

Waiver Information

 

  • Medicaid 1115 Waiver renewed October 1, 2017 – September 30, 2022. Click here to review  the updated RHP 9 Plan for demonstration years DY7-8.
  • 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
  • 23 providers participating in Delivery System Reform Incentive Payment (DSRIP) projects
  • Needs assessment: Gaps in access, behavioral health, and overall care coordination.

May to June, 2018: 

HHSC reviews and may request additional information

Saturday, June 30, 2018: HHSC approves RHP plans
July 2018: Providers receive 20% of DY7 valuation 

 

Making a Difference

Timeline for Cat C Modifications

Modification

Eligible

Providers

Deadline for Submission

Achievement Milestone Payer Type

All Providers

Prior to reporting baseline & no later than 09/01/18 (07/26 for early baseline reporting)

Reporting Milestone Payer Type

All Providers

Prior to reporting baseline & no later than 10/01/2018 (07/26/18 for early baseline reporting)

Replace a measure

CMHCs & LHDs

Prior to reporting baseline & no later than 09/01/2018 (07/19/18 for possible early baseline reporting, depending on HHSC availability)

Remove an Optional Measure

Hospital/

Physician Practice

Prior to reporting baseline & no later than 09/01/2018

 

 

  • Providers who need to request a change to a measure's achievement or reporting milestone payer type after RHP Plan Update NMI responses are submitted will submit a request through the Category C Modification Request Form. Modification Request Forms will be available to the Online Reporting System Bulletin Board July 1st. HHSC will begin reviewing requests after the RHP Plan Updates are approved. Providers should submit these request forms to the waiver mailbox as soon as possible, and no later than 07/26/18 for a measure that will be reporting a baseline in the early baseline reporting template, and no later than 09/01/18 for a measure that will be reporting a baseline in October DY7.
  • Once a measure’s baseline is reported, HHSC will review reported baselines to ensure the measure reported has significant volume for the achievement payer type. If HHSC identifies that a provider has insignificant volume for the achievement payer type, or no volume for any payer type, HHSC will be able to make modifications through the HHSC baseline technical assistance process even if the deadline for provider submission has passed. HHSC encourages providers to report baselines as early as possible to identify any concerns that might impact the milestones associated with a selected measure or measure bundle.
Summer DY7 Early Baseline Reporting
  • HHSC will be accepting early reporting of baselines in July-August 2018.
  • Standard baselines (ending 12/31/2017) and delayed baselines ending by 06/30/2018 are eligible to report baselines in the Summer DY7 Early Baseline Reporting Period.
  • HHSC encourages providers to report baselines early if possible to allow HHSC to identify any need for any possible milestone structure changes as soon as possible after the RHP Plan Updates are approved.
  • Payment for baselines reported in Summer DY7 will occur as usual following the October 2018 DY7R2 reporting period.
  • Providers could report some baselines early and others during the regular October reporting period.
Tentative Early Baseline Reporting Timeline:
  • July 2 – Cat. C Baseline Template published by HHSC
  • Week of July 9 – Cat. C. Baseline Reporting Webinar
  • August 3 – Cat. C Baseline Early Reporting Templates due to HHSC
  • August 31 – Notice of technical assistance needed sent to providers
DY7R2 October 2018 Baseline Reporting
  • Measures with a standard baseline measurement period (ending 12/31/17) who do not report baselines early, or a delayed baseline that ends by 03/31/18will be eligible to report baselines during the regular October 2018 reporting period. October DY7 is the last opportunity to report baselines for payment for both standard baselines and delayed baselines that end by 03/31/18. This does include the NMI period if providers need additional time, though this is not recommended. Providers should not delay reporting until the NMI period unless absolutely necessary as it results in significantly more work for HHSC staff and does not allow a reasonable amount of time for technical assistance. Providers are strongly encouraged to report baselines as early as possible to identify any technical assistance needs and allow time for resolution.
  • The DSRIP rules do not allow standard CY17 baseline or delayed baselines that end by 03/31/2018 to carry forward baseline reporting to the April 2019 reporting period.
  • ·§354.1713 (h)(1). Carry forward of reporting. If a performer does not report a measure’s baseline reporting milestone or performance year reporting milestone during the first reporting period after the end of the milestone’s measurement period, the performer may request to carry forward reporting of the milestone to the next reporting period.
DY8R1 April 2019 Baseline Reporting
  • Measures with a delayed baseline measurement period that ends after 03/31/2018 and on or before 09/30/2018can report in the DY7R2 October 2018 period or carryforward reporting to the DY8R1 April 2019 reporting period.
  • Providers will not be eligible to report performance for a given measure until HHSC has reviewed a baseline and approved for performance reporting. A provider with a standard baseline that reports a baseline for the first time during the October DY7 NMI period may not be eligible to report Performance Year 1 (CY2018) in April DY8, as HHSC may not have sufficient time to review baselines prior to April DY8.
  • HHSC does plan to allow interim corrections to Category C reporting, similar to the interim correction process allowed in DY2-6. HHSC current plan is to allow baselines reported during the early baseline reporting period to be corrected through the October reporting template.