RHP 17 MeetingTuesday, March 5, 2013

Overview of Meeting Provide updates from HHSC on DY1 Payments and CMS plan

review Review DY2 project activities, reporting and payments Discuss DY3 Planning Provide updated lead representative/contact changes Discuss Anchor Team restructure Q&A Next Steps/Estimated Timeline

RHP 17 Payments◦ First plan submitted to CMS◦ DY1 IGT Transfers Entered by March 7, 2013◦ DY1 IGT Transfers Processed (“Settled”) on March 8, 2013 ◦ DY1 Payments to Providers on March 28, 2013

TEXNET Reminders – IGT Transfers ◦ Use Identification Code 60500 for waiver activity transfers◦ Transfers MUST BE completed by 6 p.m. the business day prior to

IGT Settlement Date (by 6 p.m. March 7th for DY1)◦ Enter the IGT transfer for each Performing Provider being supported

as a separate transaction ◦ Submit email with Trace # (or screen shot) to HHSC

Email kellie.stephens@hhsc.state.tx.us

DY1 Payments

Based upon each providers total project value as a percentage of the entire RHP’s project value.

◦ Formula for DY1 Allocation:

◦ Example: The total project value of The Med’s Category 2 project and the corresponding required Category 3 and Category 4 projects over DYs 2-5 is $1,847,659. The total project value for all RHP 17 projects is $77,775,373. Then, multiply the percentage (.024) by the RHP 17 DY1 allocation of $7,759,584 to determine The Med’s DY1 allocation, which is $180,063.

DY1 Allocations

HHSC DY1 Payment Schedule◦ Three DY1 DSRIP Payment Cycles

1st – RHPs 14 & 17 (IGT March 7th; Payment March 28th) 2nd – RHP 8 & 7 others (IGT March 22nd; Payment April 30th) 3rd – Remaining 10 RHPs (IGT April 24th; Payment May 15th)

DY1 IGT and Payment Notification◦ HHSC sent out email March 4, 2013 with spreadsheet for confirmation

of IGT entity, IGT commitment due, and estimated DSRIP payment for each Performing Provider

◦ Anchor Team working with HHSC to update distribution list for DSRIP◦ Anchor Team working with HHSC to update any missing/incorrect

information

DY1 DSRIP (Projects) Payments

One Remaining DY1 UC Payment◦ IGT due between March 27th - April 12th ◦ Payment made on March 5th

Have submitted questions related to this DY1 UC Payment; awaiting response from HHSC◦ IGT entities and Providers should be notified approximately

one week before the IGT commitment is due ◦ Payment to providers should occur approximately three weeks

following IGT transfer

DY1 UC Payment

November 16, 2012 – RHP 17 Plan submitted to HHSC◦ 31 Category 1 & 2 projects; 34 Category 3 projects; 6 Category 4 projects◦ Total DSRIP project value - $77,775,373 ◦ Total UC funds - $184,500,000

December 21, 2012 – HHSC provided technical feedback

January 25, 2013 – Revised RHP 17 Plan submitted to HHSC

February 15, 2013 – HHSC submitted RHP 17 Plan to CMS

RHP 17 Plan

RHP 17 Plan submitted to CMS on February 15, 2013◦ Categories 1-3 – Nine projects (of 65) projects identified for minor

technical correction ◦ Category 4 – One narrative (of six) flagged; may require additional

comment by provider◦ Valuation – Three projects (of seven) remained flagged by HHSC

CMS Preliminary Feedback Received February 22, 2013◦ High-level project summary review identified two projects unlikely

to be approved Replacement projects will total same value, so RHP and provider

funding should not be negatively affected

CMS Review of RHP 17 Plan

Elective Revisions to Existing Projects ◦ Elective revisions to existing projects should NOT be submitted while

CMS plan approval pending◦ Considered project modifications & must follow outlined PFM process

Formal Review Timeline◦ CMS has 45 days to review/return comment (April 4, 2013)

CMS will approve project-by-project and not just blanket plan approval Projects not approved at 45-day review will require revision

◦ RHP 17 has 30 days to provide a response (May 5, 2013)◦ Replacement projects should be submitted prior to April 4th

(require HHSC approval before CMS review and new 45-day timeline begin)

CMS Review of RHP 17 Plan

DY2 Project Implementation◦ Providers may begin DY2 project activities at their own

discretion.

◦ Providers may begin to implement DY2 activities prior to plan approval by CMS.

◦ Regardless of how long formal plan approval takes, DY2 payments are solely tied to 100% completion of metrics.

DY2 Project Activities

Reporting Periods ◦ Reporting Period 1 – June or August 2013

Requires regional consensus of providers◦ Reporting Period 2 – October 2013

Reporting Mechanism & Process ◦ Manual mechanism for DY2 (Excel spreadsheet)◦ Working with vendor on format◦ Most likely distributed through anchor

DY2 Reporting

Review & Approval Process ◦ HHSC and CMS will concurrently review report over 30 days◦ If report is not approved during the initial 30-day review, providers will

have 15 days to revise and submit reports/additional documentation◦ HHSC and CMS will have an additional 15 days to review and approved

revised reports

Payments ◦ Approved report (documenting metrics met 100%) triggers payment ◦ If the report is not approved during the initial 30-day review, the

payment will be pushed to the next reporting period

Review and Approval of Reports

HHSC Estimated Payment Dates for DY2 DSRIP

HHSC will notify IGT entities and Performing Providers via email 7 days prior to required IGT transfer ◦ Email will contain spreadsheet outlining IGT entity, IGT commitment due and

estimated DSRIP for each performing provider ◦ Payment should be made to provider approximately 3 weeks after IGT transfer

DY2 DSRIP Payments

DY2 DSRIP

Payment Type IGT Due Payment Date

1A (of 2) – Rpt 1 June 9/9/2013 9/30/2013

1B (of 2) – Rpt 1 Aug. 10/21/2013 11/12/2013

2 (of 2) – Rpt 2 Oct. 1/3/2014 1/24/2014

HHSC Estimated Payment Dates for DY2 Uncompensated Care

HHSC will notify IGT entities and providers via email 7 days prior to requested IGT transfer◦ Email will include max amount that can be IGT’d along with UC caps◦ Email may include a UC “worksheet” to help direct payment ◦ Payment to providers should occur three weeks following IGT transfer

DY2 UC Payments

DY2 UC

Payment Type IGT Due Payment Date

Q1-Q2 (proxy) 6/10 – 6/28/2013 7/20/2013

Quarter 3 11/22 – 12/13/2013 1/16/2014

Quarter 4 2/26 – 3/10/2014 3/28/2014

HHSC maintains a distribution list of vendors paid under UPL and Transitional Waiver that is now the UC distribution list ◦ Anchor Team working with HHSC to get new and appropriate RHP 17

IGT Entities and Providers added

Several Amendments to UC Rules proposed/adopted

Additional questions related to UC process and payments submitted to HHSC; awaiting response

DY2 UC Payments

DY3 Planning Per HHSC, DY3 planning process and requirements are

still being determined

Regional DSRIP allocations should be equal to the remainder of unused funding

Anticipate planning will begin in late May/early June with completion by early September

Request for modifications to existing projects (project scope, milestones, metrics, targets, etc.) require “good cause” – written request with justification

Modifications require HHSC and CMS review/approval Modification requests must be submitted within 90

days following the end of the Demonstration Year Modification requests/assistance for RHP 17 will begin

October 1, 2013 and should be completed by December 10, 2013 for submission to/review by HHSC prior to the holiday season

Plan Modifications

Section I of the RHP 17 Plan has been revised to reflect the following:◦ Huntsville Memorial Hospital

Sally Nelson retired and Mr. Shannon Brown is the new CEOShannon L. BrownChief Executive Officer110 Memorial Hospital DriveHuntsville, TX 77340Shannon.brown@huntsvillememorial.com 936-435-2230

◦ Tri-County Services MHMR Cindy Sill retired and Mr. Evan Roberson is the new Executive Director

Evan RobersonExecutive Director PO Box 3067Conroe, TX 77305EvanR@tricountyservices.org 936-521-6119

Lead Representative Updates

Texas A&M Health Science Center assigned to provide Medicaid activity evaluation for the State ◦ Requires “fire-walling” of the various Anchor Team, Performing

Provider, and Evaluation Team activities Dr. Monica Wendel assigned to the Evaluation Team Dr. Lee Ann Ray is now the Co-Director of TAMHSC Rural

Community Health Institute which oversees all 1115 TAMHSC Waiver Activities

Ms. Angie Alaniz is now the Director, TAMHSC Anchor Teams Ms. Shayna Spurlin is now the RHP 17 Project Director Project Coordinator (TBD)

TAMHSC Restructure

Open Q&A

Follow-up questions can be emailed to Anchor for submission to HHSC or emailed directly to the HHSC with copy to Anchor Team ◦ For DSRIP and general 1115 project/report/planning

questions, email the “Waiver inbox” at: (TXHealthcareTransformation@hhsc.state.tx.us)

◦ For Uncompensated Care questions, email the “UC Tools inbox” at: (uctools@hhsc.state.tx.us)

Questions & Answers

ACTIVITY DUE DATE

IGT Transfers into TexNet for DY1 DSRIP Payments March 6th by 6 p.m.

Replacement Projects for CMS Review March 15, 2013

RHP 17 Receives formal feedback from CMS April 4, 2013

RHP 17 Revisions/Response to CMS Feedback May 2, 2013

RHP 17 DY2 Report 1 June/August 2013

RHP 17 DY3 Planning/Projects June-September 2013

RHP 17 Plan Modification Process opens October 1, 2013

RHP 17 DY2 Report 2 October 31, 2013

RHP 17 Plan Modifications w/Justification to Anchor December 10, 2013

Timeline & Tasks