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Waiver Negotiations Update
More Information...
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Waiver Negotiations Update
Jan
12
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.
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