Each regional health care partnership (RHP) in Texas was required to develop a regional plan that documented the organization and executive overview of each region, outlined community needs assessments for the counties within the region, and detailed the proposed DSRIP projects to be implemented in the region. Initial plan development and submission took place in 2012 with waiver implementation, and a process to add three-year projects was completed via plan modification in 2013.
Following two-and-a-half-years of review and revision between project providers and HHSC/CMS, all regions across the state completed plan updates and submitted fully revised plans to HHSC in May 2015. As part of the plan resubmission process, each RHP has created a "Stakeholder Resources" page to act as a central location for access to information related to the projects being implemented in each region, available opportunities to participate in regional meetings and events, as well as updated planning assessments, overviews and organization of the region.
The RHP 8 and RHP 17 Anchor teams have established this site to provide interested stakeholders information on the most current regional plan documents and the Delivery System Reform Incentive Payment (DSRIP) projects underway in our regions along with links to the original RHP Plan submissions. Additionally, links are provided to access regional and collaborative event opportunities in both regions. In some cases, the state is maintaining specific project-related documents and information. Information on the HHSC Waiver Operations Team and links to the HHSC website are included below where appropriate.
Health and Human Services Commission Waiver Operations
The Texas Health & Human Services Commission (HHSC) is the state governmental body that administers the state's Medicaid programs, including overseeing and administering the Texas Healthcare Transformation and Quality Improvement Program 1115 Waiver (the "Transformation Waiver" or "1115 Medicaid Waiver"). In this role, HHSC serves as the direct point of contact and negotiates on behalf of the state with the U.S. Centers for Medicare and Medicaid Services (CMS), the federal agency who approves and funds the waiver.
The state's 1115 Medicaid Waiver was designed to allow for expansion of Medicaid managed care programs while also helping to preserve federal supplemental funding historically provided to hospitals and physicians under the state's former Upper Payment Limit (UPL) program. The two programs under the 1115 Medicaid Waiver included as part of, and reported within, the state's 20 regional health care partnerships are the DSRIP program and the UC program.
Delivery System Reform Incentive Payment
The Delivery System Reform Incentive Payment (DSRIP) program makes incentive payments available for projects implemented under the Transformation Waiver. Eligible performing providers selected project options from a proscribed menu (the RHP Planning Protocol) with projects designed to enhance access to and availability of health care services, increase quality of existing care, improve the cost-effectiveness of care provided, and improve the health of patients and families across Texas. Projects were documented as part of an RHP Plan and incentive payments are received upon successful completion and reporting of documented metrics. Providers had the opportunity to propose four-year projects during initial waiver planning and were able to select from a modified DSRIP menu in 2013 to propose three-year projects.
The DSRIP portion of the waiver is managed by the HHSC Waiver Operations Team. Visit the HHSC Medicaid Transformation Waiver home page to learn more and to view waiver guidelines, protocols, statewide timelines, and the RHP Plans and projects for all 20 regions across the state.
The Uncompensated Care (UC) program, in conjunction with the implementation of the DSRIP program under the waiver, replaces the former Upper Payment Limit (UPL) program in Texas. As defined by HHSC, UPL was a system that provided supplemental payments to help cover the difference between what an eligible hospital or physician provider was paid by Medicaid and what Medicare would have paid for the same services if Medicaid were provided through managed care. Under the UC program, eligible hospital and physician providers can receive supplemental payments to help address expenses associated with the uncompensated care being provided to Medicaid-eligible individuals who have no funds or third-party coverage to assist with the health care treatment and services they receive.
The UC portion of the waiver is managed by the HHSC Rate Analysis Department.
The RHP 8 and RHP 17 Anchor Teams offer many opportunities for stakeholders to engage in regional events, both general meetings and more interactive collaborative events and calls. Please visit the regional pages listed below to learn more. Regional Timeline pages provide access to a calendar of upcoming regional activities and due dates, as well as historical activity data from past demonstration years. Learning Collaborative pages provide access to a calendar of upcoming regional learning collaborative events including monthly calls, cohort group meetings and semiannual face-to-face events, as well as peer opportunities offered by other regions around the state. Meeting Materials and Presentation pages provide access to agendas and other information related to upcoming and past meetings and events along with the ability to “Submit an Inquiry” to either Anchor Team to request copies of additional materials.
Original RHP Plans
RHP Four-Year Project Plans
At the initiation of the Texas 1115 Waiver, both the RHP 8 and RHP 17 Anchor Teams worked with providers and stakeholders to generate RHP Plans, which detailed four-year projects to be implemented in the region and the community needs assessments and other planning information used to inform selection of those projects. Original RHP Plans for both regions were submitted to HHSC in late 2012 and modified per CMS feedback in early 2013.
RHP Three-Year Project Plan Modifications
Throughout the summer and fall of 2013, eligible Performing Providers in each region were afforded one final opportunity to propose additional DSRIP projects to be implemented on a three-year basis. The RHP 8 and RHP 17 Plan Modifications detailing new three-year projects were submitted to HHSC in December 2013 with formal CMS approval granted in May 2014.
For more detailed information related to the timelines and approval phases associated with the plan submissions in RHP 8 and RHP 17, please visit the links below to visit the formal RHP Plan pages and to access the original four-year plans and three-year project plan modifications as submitted to HHSC.
Revised RHP Plans
Plan Revisions and Updates
Since initial plan submissions in 2012, all RHPs have been working with HHSC and CMS on detailed revisions and updates to the regional plans in an effort to more clearly define the milestones and metrics each project must achieve to demonstrate successful implementation, clarify the target population to be served by each project, estimate the anticipated patient impact of each project, and modify implementation protocols to ensure core components and quality improvement requirements are met. Plan revisions have taken place in a phased approach. Voluntary revision and initial feedback phases are now complete, with only an independent mid-point assessment conducted by Myers and Stauffer, LC, still underway.
Updated Project Metrics, Impact and Outcome Summaries
Information related to the estimated quantifiable patient impact (QPI), project milestones and metrics, Category 3 outcome measures, and project categories for all DSRIP projects across the state has been compiled and will be maintained by HHSC.
Please visit the HHSC RHP Plans page to access and download an updated list of active DSRIP projects in the state, a QPI summary file, a statewide summary of projects by type, the most recent Category 1 & 2 metric workbooks for all projects, a list of Category 3 selections for each project, and a summary of 2013 hospital data statistics for potentially preventable admissions, readmissions and complications in Texas. For assistance in navigating the Category 1 & 2 metric workbooks to view a table for each project that outlines metrics by year, please use the RHP 8 & 17 Stakeholder Reference Guide.
Updated Regional Plans
During the spring of 2015, the RHP 8 and RHP 17 Anchor teams worked with Performing Providers and other key stakeholders to compile updated RHP Plans. Updated plans include current organization and key stakeholder information, regional overviews, community needs and stakeholder engagement. In addition, the RHP Plans now include all updated three- and four-year project narratives, along with updated information on selected project outcome measures (Category 3), in one comprehensive document. Access to the individual sections of each RHP Plan are listed below. If you would like to view a copy of the consolidated plan for each region, please visit the RHP 8 Plan page and the RHP 17 Plan page.