Texas Register, Volume 38, Number 21, Pages 3215-3396, May 24, 2013 Page: 3,229
3215-3396 p. ; 28 cm.View a full description of this periodical.
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Texas 78751. Persons requiring further information, special as-
sistance, or accommodations should contact Leigh A. Van Kirk
at (512) 462-6284.
STATUTORY AUTHORITY
The new rule is 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 rule implements Texas Government Code, Chapter
531. No other statutes, articles, or codes are affected by this
proposal.
355.8203. Waiver Payments to Other Performers.
(a) Introduction. Texas Healthcare Transformation and Qual-
ity Improvement Program 1115(a) Medicaid demonstration waiver
payments are available under this section for eligible performers de-
scribed in subsection (c) of this section. Waiver payments to perform-
ers must be in compliance with the Centers for Medicare and Medicaid
Services approved waiver Program Funding and Mechanics Protocol,
HHSC waiver instructions and this section.
(b) Definitions.
(1) 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.
(2) Delivery System Reform Incentive Payments (DSRIP)-
-Payments related to the development or implementation of a program
of activity that supports a performer's efforts to enhance access to health
care, the quality of care, and the health of patients and families it serves.
(3) Demonstration year--The 12-month period beginning
October 1 for which the payments calculated under this section are
made.
(4) Governmental entity--A state agency or a political sub-
division of the state. A governmental entity includes a hospital author-
ity, hospital district, city, county, or state entity.
(5) HHSC--The Texas Health and Human Services Com-
mission or its designee.
(6) Intergovernmental transfer--A transfer of public funds
from a governmental entity to HHSC.
(7) Performer--A Medicaid provider that implements one
or more DSRIP projects. For purposes of this section, "performer" does
not include hospitals or physician practice groups as those terms are
defined in 355.8201 of this division (relating to Waiver Payment to
Hospitals) or 355.8202 of this division (relating to Waiver Payments
for Physician Services).
(8) 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.
(9) 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 systemtransformation that is driven by the needs of local hospitals, communi-
ties, and populations.
(10) RHP plan--A multi-year plan within which partici-
pants propose their portion of waiver funding and DSRIP projects.
(11) Waiver--The Texas Healthcare Transformation and
Quality Improvement Program Medicaid demonstration waiver under
1115 of the Social Security Act.
(c) Eligibility for DSRIP. For a performer to be eligible to re-
ceive DSRIP, the performer must:
(1) be actively enrolled as a Medicaid provider in the State
of Texas; and
(2) submit to HHSC documentation of completion of a
milestone or quality measure identified in the approved RHP plan.
(d) Source of funding. The non-federal share of funding for
payments under this section is limited to timely receipt by HHSC of
public funds from a governmental entity.
(e) Payment frequency. DSRIP payments will be distributed
at least annually, not to exceed two payments per performer per year.
The payment schedule or frequency may be modified as specified by
CMS or HHSC.
(f) Funding limitations. Payments made under this section are
limited by the maximum aggregate amount of funds approved by CMS
for DSRIP for each year that the waiver is in effect.
(g) DSRIP maximum payment amounts. The approved RHP
plan establishes the payment amount associated with a particular mile-
stone or quality measure. DSRIP payments cannot exceed the amount
reported in the RHP Plan.
(h) Payment methodology.
(1) Notice. Prior to making any DSRIP payments, HHSC
will give notice of the following information:
(A) the maximum payment amount for the payment pe-
riod;
(B) the maximum intergovernmental transfer amount
necessary for a performer to receive the amount described in subpara-
graph (A) of this paragraph; and
(C) the deadline for completing the intergovernmental
transfer.
(2) Payment amount. The amount of the payment to a per-
former will be determined based on the amount of funds transferred by
a governmental entity as follows:
(A) If a governmental entity transfers the maximum
amount referenced in paragraph (1) of this subsection on behalf of
a performer, that performer will receive the full payment amount
calculated for that payment period.
(B) If a governmental entity does not transfer the max-
imum amount referenced in paragraph (1) of this subsection on behalf
of a performer, that performer will receive a portion of the value asso-
ciated with that milestone or quality measure (as specified in the RHP
plan) that is proportionate to the total value of all milestones or quality
measures that are completed for that period by the performer.
(3) Final payment opportunity. A governmental entity that
does not transfer the maximum intergovernmental transfer amount de-
scribed in paragraph (1) of this subsection during a demonstration year
will be allowed to fund the remaining payments at the time of the finalPROPOSED RULES May 24, 2013 38 TexReg 3229
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Texas. Secretary of State. Texas Register, Volume 38, Number 21, Pages 3215-3396, May 24, 2013, periodical, May 24, 2013; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth313174/m1/13/: accessed April 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.