Texas Register, Volume 37, Number 34, Pages 6391-6818, August 24, 2012 Page: 6,403
6391-6818 p. ; 28 cm.View a full description of this periodical.
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The new rules are proposed under Texas Government Code
531.0055 which provides the Executive Commissioner of
HHSC with rulemaking authority; and Texas Human Resources
Code 32.021 and Texas Government Code 531.021 which
authorize HHSC to administer the federal medical assistance
(Medicaid) program in Texas.
The new rules affect the Texas Human Resources Code, Chap-
ter 32, and the Texas Government Code, Chapter 531.
354.1601. Introduction.
(a) The purpose of this subchapter is to govern implementation
of the demonstration waiver under 1115 of the Social Security Act,
entitled "Texas Healthcare Transformation and Quality Improvement
Program" (the waiver).
(b) Subject to approval by the Centers for Medicare and Med-
icaid Services of all required protocols described in the waiver, this
subchapter describes the criteria for participation in a Regional Health-
care Partnership and the allocation and use of waiver funds.
(c) Rules related to reimbursement for hospitals and physician
services under the waiver are codified at 355.8201 of this title (relating
to Waiver Payments to Hospitals) and 355.8202 of this title (relating
to Waiver Payments for Physician Services).
354.1602. Definitions.
The following terms, when used in this subchapter, have the following
meanings unless the context clearly indicates otherwise.
(1) Administrative Cost Claiming Protocol--A document
that explains the process the State will use to determine administra-
tive costs incurred under the waiver.
(2) Anchor--The governmental entity identified by HHSC
as having primary administrative responsibilities on behalf of a Re-
gional Healthcare Partnership (RHP).
(3) Centers for Medicare and Medicaid Services (CMS)--
The federal agency within the United States Department of Health and
Human Services responsible for overseeing and directing Medicare and
Medicaid, or its successor.
(4) Delivery System Reform Incentive Payment (DSRIP)-
-An incentive payment related to the development or implementation of
a program of activity that supports an RHP's efforts to enhance access
to health care, the quality of care, and the health of patients and fami-
lies the RHP serves. A DSRIP payment is not considered patient-care
revenue and is not offset against Disproportionate Share Hospital ex-
penditures or other expenditures related to the cost of patient care.
(5) Demonstration year--A 12-month period beginning Oc-
tober 1 and ending September 30.
(6) DSRIP pool--Funding available to RHP participants
under the waiver to compensate them for the value of DSRIP projects.
(7) DSRIP project--An activity selected from the RHP
Planning Protocol for implementation in an RHP plan.
(8) Governmental entity--A state agency or a political sub-
division of the state, such as a city, county, hospital district, hospital
authority, or state entity.
(9) HHSC--The Texas Health and Human Services Com-
mission or its designee.
(10) Intergovernmental transfer (IGT)--A transfer of public
funds from a governmental entity to HHSC.
(11) IGT entity--A governmental entity that provides an
IGT to fund the non-federal share of the waiver.(12) Medicaid provider--An entity approved by HHSC to
provide Medicaid services.
(13) Metric--A quantitative or qualitative indicator of
progress from a baseline toward achieving a milestone.
(14) Milestone--An objective of DSRIP project perfor-
mance comprised of one or more metrics. Process milestones are
objectives for completing a process that is intended to assist in achiev-
ing an outcome. Improvement milestones are objectives for improved
outcomes.
(15) Participant--An entity participating in an RHP. A par-
ticipant may be an IGT entity, a performer, or another stakeholder.
(16) Performer--A participating Medicaid provider that
implements one or more DSRIP projects.
(17) Program Funding and Mechanics Protocol (PFM)--A
document containing the waiver program guidelines as agreed upon by
HHSC and CMS.
(18) Public funds--Funds derived from taxes, assessments,
levies, investments, and other public revenues within the sole and un-
restricted control of a governmental entity. Public funds do not include
gifts, grants, trusts, or donations, the use of which is conditioned on
supplying a benefit solely to the donor or grantor of the funds.
(19) Regional Healthcare Partnership (RHP)--A collabora-
tion of interested participants that work collectively to develop and
submit to the state a regional plan for health care delivery system re-
form. Regional Healthcare Partnerships will support coordinated, ef-
ficient delivery of quality care and a plan for investments in system
transformation that is driven by the needs of local hospitals, communi-
ties, and populations.
(20) RHP allocation--An amount of DSRIP funds allocated
to a specific RHP during the DSRIP planning process.
(21) RHP plan--A multi-year plan submitted to HHSC and
CMS, as further described in 354.1621 of this subchapter (relating to
RHP Plan).
(22) RHP Planning Protocol--A master list of potential
DSRIP projects, as well as milestones and metrics applicable to those
projects.
(23) Uncompensated care (UC) costs--For services that
meet the definition of "medical assistance" contained in 1905(a) of
the Social Security Act:
(A) the difference between Medicaid payments to a
provider and the provider's cost of providing services to a Medic-
aid-eligible individual; or
(B) the cost of care provided to an uninsured individual
who has no source of third-party coverage for the service provided.
(24) UC hospital--A hospital eligible to be a performer that
chooses to receive only UC payments.
(25) UC pool--Funding available to RHP participants, as
well as dental and ambulance providers, under the waiver to defray
uncompensated care costs.
(26) Waiver--The Texas Healthcare Transformation and
Quality Improvement Program demonstration waiver under 1115 of
the Social Security Act.
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal author-
ity to adopt.PROPOSED RULES August 24, 2012 37 TexReg 6403
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Texas. Secretary of State. Texas Register, Volume 37, Number 34, Pages 6391-6818, August 24, 2012, periodical, August 24, 2012; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth253226/m1/12/: accessed April 19, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.