RHP9 Updates

Many of our waiver providers in RHPs 2, 3, and 7 were impacted by Hurricane Harvey.  The DSRIP team is analyzing options for DSRIP but would need CMS approval for anything outside the parameters of the DY6 Program Funding and Mechanics Protocol (PFM) and program rules.

• HHSC completed additional reviews related to results of past audits.
• Ongoing work: HHSC is working with MSLC to go through results of MSLC’s most recent reviews on Categories 1, 2 and 3.

• HHSC will develop a FAQ on system definition – to be released on September 15^th. 
• The FAQ will be updated regularly.
• Please also review the HHSC responses to provider feedback on the Measure Bundle Protocol. Many questions have been addressed therein.

• The DY7-8 PFM defines MLIU as the following:
  • Medicaid and Low-income or Uninsured (MLIU)
  • To qualify as a Medicaid individual for purposes of MLIU Patient Population by Provider (PPP), the individual must be enrolled in Medicaid at the time of at least one encounter during the applicable DY.
  • To qualify as a low-income or uninsured individual for purposes of MLIU PPP, the individual must either be below 200 percent of the federal poverty level (FPL) or must not have health insurance at the time of at least one encounter during the applicable DY.
  • If an individual was enrolled in Medicaid at the time of one encounter during the applicable DY, and was low-income or uninsured at the time of a separate encounter during the applicable DY, that individual is classified as a Medicaid individual for purposes of MLIU PPP.
• In response to provider feedback on the PFM, HHSC clarified the following:
  • The MLIU definition remains the same as the DY6 definition: Medicaid, Low-income (under 200% FPL), or uninsured. Medicaid may include individuals with Medicaid as secondary coverage and individuals that are dual-eligible for Medicaid and Medicare. Low-income may include patients at or below 200% FPL, including patients that have insurance coverage through a local coverage option, CHIP, or a plan in the Federal exchange. Providers who do not have systems in place to evaluate income status do not need to include low-income in their MLIU count. A provider would be authorized to only count individuals with Medicaid and individuals without insurance. Since Category B will be a maintenance goal, providers need to ensure that they use the same criteria for counting the MLIU population for the baseline period and achievement period reporting. However, providers will not be penalized for their initial MLIU population volume submitted in the RHP Plan Update.
  • Providers may not use a proxy estimate for determining their MLIU or Total PPP for DY7-8.