This page gives you access to the latest information regarding the Medicaid 1115 Waiver. As information becomes available, TAC will continue to update this page with articles, documents and news.
 Action Required - UPDATED ANCHOR LIST & RHP MAP
The Texas Health and Human Services Commission has released an updated Anchor list and Regional Healthcare Partnership Map, dated May 11, 2012 - both of which are based on RHP confirmation forms submitted to HHSC in April. According to a HHSC release, the commission attempted to incorporate all submitted requests into the new map but could not in all cases due to geographic proximity and conflicting submissions. In updating the map, HHSC considered the RHP principles (dated April 2, 2012). HHSC only included requests submitted in an RHP Confirmation Form via the waiver email address or fax by April 24, 2012.
Final Chance to Comment: Please review the map and confirm your county’s region. If you are not in a region that you prefer or if the choice of anchor is still in dispute, then you should plan to request changes via in-person testimony at the May 17, 2012 public hearing.
If you are interested in listening in on the hearing, a conference call line is available for out-of-town stakeholders. Please note: stakeholders wishing to testify need to attend the hearing in person. Testimony will not be allowed over the conference call line.
Conference Call Number – 1-877-226-9790 Access Code – 8317345
Please note: the public hearing will discuss the May 11, 2012 map, not the March 30, 2012 map.
**A few important items not included in the attached notices that HHSC would like to share with stakeholders include:
- The public hearing will start promptly at 1:30 p.m. HHSC will hear public testimony until each person who wishes to speak has an opportunity to present. If testimony ends before 4:30 p.m., the hearing will end early. Those interested in speaking at the public hearing should plan to arrive by 1:30.
- The purpose of the hearing is for Executive Commissioner Tom Suehs to hear from entities in RHPs that are still in contention (either counties disagreeing with RHP placement on the May 11, 2012 map or an RHP anchor still in question) in order to finalize RHP region development. HHSC requests those counties and anchors in question to please attend the public hearing to voice concerns to the Executive Commissioner. The Executive Commissioner will take these public hearing comments into consideration when developing the final RHP geography and anchors. HHSC will issue the final RHP map shortly following the public hearing based on the Executive Commissioner’s final recommendations and submit to CMS for federal approval.
- HHSC encourages RHP participants to work together prior to the public hearing to determine RHP geography and anchors.
- During the public hearing, HHSC intends to accept comments in response to the May 11, 2012 RHP map, not the March 30, 2012 RHP map.
- Depending on the amount of public comment during the hearing, the 3-minute presentation rule may be invoked.
- HHSC continues to work with CMS to determine how an IGT entity can fund a performing provider in a different RHP based on certain principles. For instance, total computable payment must stay with the recipient. HHSC recognizes that IGT crossing regions is particularly important for specialty providers—such as children’s hospitals or burn care—that may serve more than one RHP.
TAC will continue to provide information as it becomes available. For questions, please contact Rick Thompson at (800) 456-5974 or rickt@county.org.
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 View the HHSC testimony to House Committee on County Affairs May 1, 2012. Please note page 12 of presentation illustrates important dates including May 17 2012, HHSC will hold a public hearing in Austin to confirm the RHPs on the map.
1115 Waiver Rules Open for Public Comment
The Health and Human services Commission (HHSC) published proposed waiver reimbursement rules for hospitals and physician services on the Texas Register website. The rules were published in the April 20, 2012 edition of the Texas Register, which triggers the 30-day comment period.
These rules provide detailed direction for waiver program participation including information regarding county requirements. Waiver Payments to Hospitals (#2 below) gives more direction for county involvement.
- TAC §355.8066 (Hospital Specific Limit Methodology) may be viewed here. The hospital specific limit methodology is used in the calculation of a hospital’s uncompensated-care waiver payments and disproportionate-share hospital program payments.
- TAC §355.8201 (Waiver Payments to Hospitals) may be viewed here.
- TAC §355.8202 (Waiver Payments for Physician Services) may be viewed here.
If you are interested in providing comments on the proposed waiver reimbursement rules, you may do so either at the public hearing or by submitting them to HHSC as explained below. Should you county provide comments; please copy Rick Thompson at rickt@county.org.
Public Hearing
The Medical Care Advisory Committee (MCAC) meeting on May 10, 2012, will function as a public hearing to receive public comment on these proposed rules. The MCAC meeting will be held in the John H. Winters Public Hearing Room at 701 West 51st Street, Austin, Texas. Entry is through security at the main entrance of the building, which faces 51st Street. Persons requiring American with Disabilities Act (ADA) accommodation or auxiliary aids or services should contact Carol Chavez by calling (512) 491-1763 at least 72 hours prior to the meeting to make appropriate arrangements.
Public Comment
Written comments on the proposal may be submitted to Jill Seime, Hospital Rate Analysis Department, Texas Health and Human Services Commission, Mail Code H-400, P.O. Box 85200, Austin, TX 78708-5200, by fax to (512) 491-1436, or by e-mail to costinformation@hhsc.state.tx.us within 30 days of publication of this proposal in the Texas Register.
The proposed waiver reimbursement rules for hospitals and physician services are now available for viewing on the Texas Register website. The rules will be published in the April 20, 2012 edition of the Texas Register, which triggers the 30-day comment period.
1) Proposed RHP Map – This updated map (dated March 31, 2012) of the proposed RHPs by geographic area is based on hundreds of responses to the HHSC preliminary map. Further details concerning how HHSC developed this map are included under “RHP Principles.” Please review the map and confirm you are in the region your county prefers. If you are not satisfied, please see #4 RHP Confirmation Form below.
2) RHP Principles –
This document includes an overview of HHSC’s approach to updating proposed RHPs based on stakeholder feedback, as well as next steps and general RHP development guidelines. The intent of these guidelines is to define an RHP, outline terms of RHP participation, and clarify the anchor role. TAC and the County Judges and Commissioners Association are working to get more direction from HHSC on specific county-related projects. If you have questions about whether prospective projects will qualify for Intergovenmental Transfers (IGT), send your specific examples to Rick Thompson and we will submit them to HHSC.
3) Preliminary Anchors –
RHP participants can use this list of preliminary anchors by RHP region to assist with regional planning. HHSC included on this list all proposed RHP anchor entities submitted in response to the February 2012 RHP map survey except for entities that HHSC determined cannot be anchors. This list only includes those entities who have expressed interest in serving as an anchor from the RHP Preliminary Survey therefore additional anchoring entities are not listed. Please review the list of prospective anchors and if your region has multiple candidates, consider supporting your preferred anchor and file letters or resolutions with HHSC before the April 24 deadline.
4) RHP Confirmation Form - Each RHP anchor must complete this form and submit it to HHSC by April 24, 2012, to determine the geographical boundaries of the RHP. The form may be used to either confirm or suggest changes to HHSC’s proposed RHP map. HHSC will only accept one form from: (1) each anchoring entity, and (2) for those with conflicts in RHP placement, a county. Further instruction is included in the attachment. If your county is not satisfied with the Proposed RHP Map, it has been suggested when sending this form to HHSC, your county should copy your members of the legislature.
5) April Outreach Plan –
This outreach plan is a schedule of 21 webinars / conference calls throughout April 2012 intended to help participants finalize RHP regions by May 1. An April 9, 2012, kick-off webinar / call will go over each of the tools provided in this email. On April 10, 2012, HHSC will review a draft of the Delivery System Reform Improvement Plan (DSRIP) menu. From April 13 to April 20, 2012, HHSC will hold a webinar / conference call with each of the proposed RHP regions to discuss the updated map and any regional concerns in RHP development. Please note the first webinar is Monday, April 9, 2012, 3-4:30pm – 1115 Transformation Waiver Update: Overview of RHP Development.
6) DRAFT DSRIP Menu –
HHSC developed this draft DSRIP menu with guidance from the Clinical Champions Workgroup and the Texas Medical Foundation Health Quality Institute. Comments will be due to TX-DSRIP@tmf.org by April 23, 2012. HHSC will soon post on the website instructions how to submit comments on this draft menu. On April 10, 2012, HHSC will review a draft of the DSRIP menu. If submitting comments on this draft menu by April 23, 2012 please copy Rick Thompson.
7) DSRIP menu overview – This is a supplemental guide to the Draft DSRIP menu provided above. On April 10, 2012, HHSC will review a draft of the DSRIP menu.
1115 Waiver Newsletter Articles
This series of articles will provide an overview of the progress made regarding the waiver, including waiver background and legislative hearings.
March 19 - HHSC Working to Establish Guidelines for 1115 Medicaid Waiver
Jan. 20 - HHSC Offers Detail About Changes, Access to UPL Funding
Dec. 15 - CMS Approves Waiver Allowing Texas to Expand Managed Care
Sept. 29 - County Affairs Holds Hearing on Health Care Reform
Webinar
County Officials Invited to Medicatd Waiver Webinar, Live Meetings.
Presentation of Texas Health Care Transformation 1115 waiver.
View a draft template from HHSC on the Regional Healthcare Plan. Please discuss the plan with your local healthcare providers and provide feedback if items need additional clarification, reorganization, or removal.
Questions & Answers
List of questions and answers regarding the waiver including Regional Health Partnerships guidelines.
A power point presentation given by Maureen Milligan, Deputy Director for Quality and Cost Containment for Medicaid/CHIP. The presentation gives an overview of the recently approved 1115 Medicaid Waiver and how it could impact counties. This was presented to commissioners court members at the V.G. Young Institute School for County Commissioners Courts on February 8, 2012.
Roles & Responsibilities
HHSC document that gives details to a Regional Healthcare Partnership including roles and responsibilities of participants and principles.
Waiver Process
A detailed approval letter to HHSC illustrating expectations, performance measures and procedures for the 1115 Waiver process.
Proposed Regional Health Partnership Map
The federal waiver must include all areas of the state, therefore all counties who do not choose to participate within a contiguous RHP region will be assigned to one. If assigned to a region, your county is not obligated to participate in the waiver program or commit any local property tax dollars.
Preliminary RHP Regions Survey
If your county has any interest in the program, please complete the survey from the Texas Health and Human Services Commission on the new 1115 Medicaid Waiver Program.
For more information visit the Health and Human Services Commission 1115 Waiver homepage.
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