Texas Hospital Association Annual Conference Steve Aragón, Chief Counsel Texas Health and Human Services Commission Stacy E. Wilson, J.D., Associate General Counsel Texas Hospital Association February 14, 2013 Medicaid 1115 Transformation Waiver: Where are We Now?
20
Embed
Texas Hospital Association Annual Conference Steve Aragón, Chief Counsel Texas Health and Human Services Commission Stacy E. Wilson, J.D., Associate General.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Texas Hospital AssociationAnnual Conference
Steve Aragón, Chief CounselTexas Health and Human Services Commission
Stacy E. Wilson, J.D., Associate General CounselTexas Hospital AssociationFebruary 14, 2013
Medicaid 1115 Transformation Waiver: Where are We Now?
Why A Waiver?
Budget issues during the 2011 session led to need for cost savings
Upper Payment Limit Program - $2.8 billion/year (AF)
Eliminated due to statewide expansion of managed care
Need to save supplemental funding to hospitals 2
What Does This Waiver Do?
More money available?– $29 billion over 5 years vs.
$14 billion under UPL
– But budget neutral to the federal government; i.e., feds would have spent the same amount of money
– IGT capacity
Creates two funding pools– Uncompensated Care Pool
– Delivery System Reform Incentive Payment Pool 3
Structural Overview
4
UC and DSRIP Funding
DY 1(2011-12)
DY 2(2012-13)
DY 3(2013-14)
DY 4(2014-15)
DY 5(2015-16)
Total
UC $3.7 B $3.9 B $3.534 B $3.348 B $3.1 B $17.582 B
DSRIP $500 M $2.3 B $2.666 B $2.852 B $3.1 B $11.418 B
Total/DY $4.2 B $6.2 B $6.2 B 6.2 B $6.2 B $29 B
% UC 88% 63% 57% 54% 50% 60%
% DSRIP 12% 37% 43% 46% 50% 40%
5
Regional Healthcare Partnerships
20 regions proposed based on UPL affiliations and feedback
Each region has:– Anchor
– Funding public entities
– Performing providers
6
Uncompensated Care Pool
Uncompensated Care– Supplements hospitals for
Medicaid underpayment and uninsured Medicaid and uninsured
shortfalls not covered by DSH
Additional categories of Medicaid & uninsured costs can be claimed
– Physicians
– Clinics
– Pharmacies 7
DSRIP Projects
TYPES OF CATEGORY 1 PROJECTSPay for Performance
• Expand Primary Care Capacity• Increase Training of Primary Care
Workforce• Implement and Use a Chronic Disease
Management Registry• Expand Urgent Care Access• Expand Dental Services• Behavioral Health Projects
TYPES OF CATEGORY 2 PROJECTSPay for Performance
• Expand/ Enhance Medical Homes• Expand Chronic Care Management
Models• Redesign Primary Care• Establish/Expand a Patient Care