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)

Tuesday May 22-23, 2018:  2018 RHP 9, 10 & 18 Collaborative Connections - Impacting CareRegistration at https://2018collaborativeconnectionsimpactingcare.eventbrite.com
2018: TBD:  RHP9 Plan Submission and Updated Community Needs Assessment

 

Making a Difference

Waiver Negotiations Update
  • Yesterday Commissioner Smith hosted a meeting on the waiver renewal.  I have attached the documents from the meeting. 

     

  • UC Pool and Payment Changes
    • Pool size will be approximately $3.1 billion in DY 7 and DY 8. Pool sizes for DY 9 - 11 will be resized based on hospital charity care costs provided in Federal Fiscal Year (FFY) 2017.
    • It will be essential for all providers to accurately report charity care costs for 2017 for the resizing exercise. The UC pool size may temporarily default to a reduced amount of $2.3 billion for DY 9 - 11 until all charity costs are accurately reported. The pool will ultimately be reconciled to reflect the final charity care data and may be more or less than $2.3 billion depending on the data.
    • Charity care costs will be determined by information in Worksheet S-10 of the Medicare hospital cost report (Form CMS-2552-10). For hospitals not required to complete the S-10, which are primarily children’s, cancer, and rehabilitation hospitals, and Institutions of Mental Disease) and for non-hospital qualifying providers, an alternate methodology using CMS-approved cost reports will be used to determine charity costs.
    • Beginning in DY 9, UC pool payments will be based on charity costs incurred by qualifying providers and must exclude amounts for Medicaid shortfall as CMS prefers that reimbursement rates be adequate to cover Medicaid costs. Providers receiving both DSH and UC payments cannot be paid more than total eligible uncompensated costs.
    • The UC payment protocol must include precise definitions of eligible uncompensated provider charity care costs for each qualifying provider type.

     

  • UC Protocol and Rules Schedule
    • Draft UC protocol is due to CMS by March 30, 2018. Approval expected in 90 days.
    • Draft Texas Administrative Code rule on UC payments to be published by July 31, 2018.
    • Revised draft UC applications to CMS by May 1, 2019. Approval required by August 31, 2019.
    • Revised UC protocol to be implemented by October 1, 2019.
    • Final Texas Administrative Code rule on UC payments to be published by January 30, 2019, and effective by September 30, 2019.
    • Failure to meet any of these deadlines will result in a 20% reduction in expenditure authority from the UC pool for the program year. The reductions are cumulative.

     

  • DSRIP
    • The DSRIP funding pool has been extended four years, through September 30, 2021. Pool sizes are $3.1 billion in DY 7 and 8, $2.91 billion in DY 9, $2.49 billion in DY 10, and $0 in DY 11.
    • CMS and HHSC to finalize RHP Planning Protocol and the Program Funding and Mechanics Protocol by January 21, 2018.
    • Draft DSRIP transition plan due to CMS by October 1, 2019 to describe how the state will further develop its delivery system reform efforts when DSRIP funding is no longer available. Transition plan to be finalized by end March 2020 (DY 10).

     

  • Category B:   If you have outstanding questions from December related to system definitions or Category B, please feel free to resend these questions to the waiver mailbox.

 

  • Category C
    • The first round of FAQ on the draft Measure Specifications has been posted on the DSRIP Online Reporting System bulletin board in October.  HHSC continues to review questions. 
    • Attached are the latest Cat C Specification FAQ

     

  • Rules:  The DSRIP DY7-8 rules were published as adopted in the November 24, 2017, issue of the Texas Register with an effective date of December 1, 2017. HHSC is currently working to amend these rules to reflect the most recent versions of the DSRIP protocols as of December 22, 2017. HHSC anticipates that the amendments will be published as proposed in the January 19, 2018 issue of the Texas Register, for an anticipated effective date of April 2018. These rules will need to be further amended once HHSC and CMS have finished negotiating the DSRIP protocols, such as potentially narrowing the current range of distributing Category C valuation among Measure Bundles/measures and adjusting rules for P4P measures that are high performing at baseline. 
October DY6 Reporting
  • Reminder that NMI will close on 1/16/18, however an email reminder will not go out as the system will remain open for the providers impacted by Hurricane Harvey. 
  • Payment Timeline:  January 18 for the transferring hospitals and Top 14 IGT Entities;  January 31 for remaining providers and DY5 payments for all providers. 
  • QPI NMI:  Utilize the October DY6 QPI Reporting Template
  • Category 3 NMI:  There is a specific Cat 3 NMI Template that must be used for reporting NMI. If you didn’t receive an NMI, please do not rely on the NMI reporting template to confirm DY6 R2 reporting. HHSC posted an updated Summary Workbook to the online reporting system on January 11. Please rely on this information rather than the template.
Compliance Monitoring
  • MSLC Is continuing its work with Category 1 and 2 and Category 3 reviews.
  • HHSC continues finalizing results for Category 1 and 2 Round 3, and the process will continue for several weeks, depending on the resolution or need for clarification for some projects.
  • MSLC has started documentation requests and reviews for Category 3 Round 3 Performance Reviews. We anticipate that this round of reviews will be completed by May 2018 for most projects.
Waiver Renewal
  • Waiver Negotiations Update
    • Communications are still ongoing with CMS and updates will be provided as they are available, including timelines.
    • CMS is currently reviewing the proposed Program Funding and Mechanics Protocol (PFM), the Measure Bundle Protocol (MBP), and the draft Measure Specifications.
  • Category C
    • The first installment of an FAQ based on the questions and feedback submitted on the draft Measure Specifications document will be posted early this week on the online reporting system bulletin board.
    • Over 1,000 individual questions were submitted to HHSC.  Many cannot be answered without program approval by CMS.
    • Questions can continue to be submitted to the HHSC box but please do not resubmit questions. 
    • HHSC has received a number of comments regarding the administrative complexity of the measure specifications source for measure J1-222 Severe Sepsis and Septic Shock Management Bundle (NQF 0500) and will be evaluating alternative specifications sources.
  • Rules
    •  The DSRIP DY7-8 rules were published as adopted in the November 24, 2017, issue of the Texas Register with an effective date of December 1, 2017. HHSC is currently working to amend these rules to reflect the most recent versions of the DSRIP protocols as of December 22, 2017. HHSC anticipates that the amendments will be published as proposed in the Texas Register in January 2018, for an anticipated effective date of April 2018. HHSC also anticipates that the rules may need to be further amended once HHSC and CMS have finished negotiating the DSRIP protocols.