The following message from sent by HHSC on Thursday, March 12, 2015:
Transformation Waiver Stakeholders –
We want to provide you an update on HHSC’s recent visit to Baltimore to discuss with CMS the renewal/extension of the 1115 Transformation Waiver and how to move forward to address the concerns CMS raised in the September 2014 UC deferral letter regarding IGT financing for private hospitals.
Chris Traylor, Kay Ghahremani and Monica Leo met with key CMS staff on Monday, including Vikki Wachino (Acting Director, Center for Medicaid and CHIP Services, acting in Cindy Mann’s former role), Tim Hill (Finance), Kristin Fan (Finance), Eliot Fishman (Director, Children and Adults Health Programs Group, which oversees 1115 waivers), and Brenda Blunt (HHSC’s waiver project officer).
HHSC sent CMS four documents in advance of the meeting – agendas for each of the topics and a draft of the Transition Plan for the Pools that HHSC is required to submit to CMS later this month along with an attachment to the transition plan.
Agenda for Meeting with CMS re: Waiver Transition
STC 48 Transition Plan Draft 20150302
STC 48 Transition Plan Attachment A
Agenda for Private Hospital Funding Meeting
Waiver Extension/Renewal and the Pool Transition Plan due March 31st
There were no big surprises in the meeting. The comments from CMS regarding waiver renewal/extension were similar to messages they’ve conveyed both in Texas and nationally recently. As we assumed, Texas will need to make a strong case to CMS to continue the DSRIP and UC pools beyond the original 5-year waiver term. We’re committed to working with you to make that case, and HHSC emphasized for CMS the key points in the first attached agenda. Some highlights from the meeting:
- HHSC: DSRIP and the RHP structure have enabled locally driven, provider-level innovation, which is so important to improving how care is delivered.
- CMS acknowledged that the Texas DSRIP program took long to get up and running, so we will want to continue to strongly make this point as part of our argument to extend DSRIP.
- CMS: DSRIP is hard to administer in Texas (and other states) and CMS is uncertain about what return it’s getting for its large investment.
- CMS wants further alignment of Texas Medicaid quality efforts and to further value based payment within Medicaid managed care.
- Of different states’ DSRIP programs, CMS thinks the New York model is well designed. (HHSC already is looking into the NY model, and what elements from it may be applicable to TX.)
- CMS wants a sustainability plan for DSRIP and UC; it is hesitant about ongoing supplemental payments and would rather see increases in Medicaid payment rates. (CMS noted that another way to reduce Texas’ UC burden would be insurance coverage expansion.)
- CMS Financial staff acknowledged they understood the importance of these funds to help support Texas’ safety net providers.
HHSC plans to submit the attached transition plan to CMS by the deadline of March 31, 2015. Many of you provided input on an earlier draft that was incorporated into this version. If you see anything in this final draft that you think is factually incorrect, please let us know as soon as possible.
Private Hospital IGT Financing
Regarding the UC deferral issue, CMS Financial staff provided HHSC a binder in response to the letter HHSC sent CMS in December. The attached 17 PDF documents are the entire contents of the binder by tab. HHSC is sharing the full binder with all of you because we know this issue has potential statewide implications and will need your assistance to continue to make our case to CMS regarding waiver financing. As you can see from the contents of the binder, CMS has reviewed this issue in detail; however, it’s unclear at this point to what extent their General Counsel has been involved in the response. We’ll follow up with them to ask whether their Legal team has reviewed. HHSC plans to review this issue internally and will work closely with impacted stakeholders before responding back to CMS on the points they made in the binder.
Table of Contents Tab1 Tab2 Tab3 Tab4 Tab5 Tab6 Tab7 Tab8 Tab9 Tab10 Tab11 Tab12 Tab13 Tab14 Tab15
Chief Deputy Medicaid/CHIP Director for Policy and the Transformation Waiver
Texas Health and Human Services Commission