1115 Waiver Negotiation Update

HHSC is now requesting an additional 21 months of level funding for the UC and DSRIP pools, and a continuation of the managed care provisions of the 1115 Waiver, through Sept. 30, 2019.

We believe this extension is necessary to allow the new administration and the 115th Congress to make changes to the nation's health care system, and the Medicaid program specifically, during 2017. The 21 additional months also allows for the 86th Legislature to respond to any federal changes and sufficient time for Texas to develop a new 1115 Waiver proposal. This extension would provide financial and operational certainty for Texas providers to continue serving Medicaid and low-income uninsured populations that benefit from the waiver while the Trump administration determines its policies regarding Section 1115 Demonstration Waivers.

If you have any questions, please email your question to TXHealthcareTransformation@hhsc.state.tx.us.

The Texas 1115 Medicaid Transformation Waiver is a five year waiver expiring on Sept. 30, 2016. Pursuant to the waiver's terms and conditions, Texas submitted a waiver extension request to the Centers for Medicaid and Medicare Services (CMS) on Sept. 30, 2015.

Letter to CMS on Waiver Extension

On Oct. 6, 2016, HHSC sent the letter below to CMS in advance of negotiations on the 1115 Waiver extension. The waiver extension application submitted in Sept. 2015 was attached to the letter.

On Aug. 19, 2016, HHSC sent a letter to CMS to facilitate discussions on the longer term extension of the Medicaid 1115 Demonstration Waiver. The letter specifies that HHSC is on track to submit the required independent report analyzing the Uncompensated Care pool and Delivery System Reform Incentive Payment (DSRIP) program on Aug. 31, 2016. The letter also states that HHSC seeks a clear understanding of CMS' vision for DSRIP integration into Medicaid managed care and HHSC's vision for the longer term extension. The HHSC proposal that is in development includes both a glide path for the integration of DSRIP into managed care for Medicaid beneficiaries and the continued support of locally directed interventions for the continued transformation of the health care system for all Texans. The letter is linked below.

Uncompensated Care Evaluation and Report

The Standard Terms and Conditions for the 15-month waiver extension require Texas to submit a report conducted by an independent evaluator of the state's Uncompensated Care (UC) program that studied the impact of the UC pool on overall UC in the state, Medicaid provider rates, Medicaid beneficiary access to services, and a number of other areas. The report was submitted to CMS on Aug. 31, 2016 and is linked to below.

15-Month 1115 Waiver Extension

HHSC and the Centers for Medicare and Medicaid Services (CMS) have agreed to a 15-month extension of the Texas 1115 Waiver. The agreement will take the program through December 2017 and will maintain its current funding. HHSC and CMS will continue negotiating a longer term extension. Please see below for the extension approval letter from CMS and the Standard Terms and Conditions (STCs) for the extension.

HHSC has submitted a request to the Centers for Medicare and Medicaid Services (CMS) for an initial 15-month extension of the 1115 Medicaid Demonstration Waiver, as specified in the letter below. The purpose of this initial extension is to allow time for state and federal governments to work through a longer term agreement, which is most important for Medicaid beneficiaries in Texas.

DSRIP Extension - Planning and Protocols

The following documents are HHSC proposals for DSRIP during the waiver extension period. All proposals are subject to approval by the Centers for Medicare and Medicaid Services (CMS).

Draft Program Funding and Mechanics Protocol (PFM) for Demonstration Years (DY) 7-8

HHSC has developed a draft DSRIP PFM that describes proposed requirements for DSRIP participation in DY 7-8. This draft PFM has not been submitted to CMS for approval and is posted for stakeholder information and feedback only. Posted below are also two companion documents to the draft DY 7-8 PFM.

Stakeholders can now take a survey on the Draft DY7-8 PFM. The survey will close on Feb. 28, 2017 (2/16/17).

RHP Planning Protocol for Demonstration Year 6A

HHSC has submitted to CMS an addendum to Attachment I of the RHP Planning Protocol for Demonstration Year 6A. Changes to the RHP Planning Protocol for DY6A are consistent with the approved DY6 Program Funding and Mechanics Protocol (PFM).

DY6 Program Funding and Mechanics (PFM) Protocol

CMS has approved the DY6 Program Funding and Mechanics (PFM) Protocol, which is Attachment J in the waiver's Special Terms and Conditions. The PFM lays out the revised guidelines by which DSRIP projects will operate in DY6. The approval letter from CMS and the approved PFM are linked to below.

Stakeholder Feedback

Feedback on the 1115 Transformation Waiver Extension request received from stakeholders at public meetings held in 2015 and in previous surveys can be found in the 1115 Waiver Extension Request Stakeholder Feedback spreadsheet below. This document describes DSRIP proposals in the extension request, where they can be found in the current waiver, if applicable, proposed effective dates for each proposal, and a summary of stakeholder comments received so far on each proposal. This document will be updated periodically as additional comments are received and CMS provides any feedback.

Extension Application Submission

Texas has submitted the 1115 Transformation Waiver Extension Application to CMS. Below please find links to the submitted cover letter, application and interim evaluation report.

1115 Waiver Extension Application Draft

The document posted below is the 1115 Waiver Extension Application Draft, attachments and Public Notice. HHSC will be taking comments on this draft during July at the statewide public meetings listed below.

To obtain copies of the renewal application, submit comments or receive other information about the renewal, interested parties may also contact Mike Erwin by mail at Texas Health and Human Services Commission, PO Box 13247, Mail Code H-600, Austin, Texas 78711-3247, phone (512) 424-6549, fax (512) 730-7472, or by email at TX_Medicaid_Waivers@hhsc.state.tx.us.

Statewide Public Meetings on the 1115 Waiver Extension Application

Summary of Comments from Public Meetings

The document below contains summaries of comments received during the statewide public meetings, including the webinar, that were held on the 1115 Waiver Extension Application. The summary was prepared for HHSC's review to assist with finalizing the waiver extension request. Please note that the meetings are listed in the document alphabetically by city, rather than by date.

Discussion of Key DSRIP Issues

At the Executive Waiver Committee held on May 14, 2015, HHSC outlined several proposed components on how to continue and strengthen the DSRIP program in the waiver renewal period. Please see the document "Waiver Renewal - Discussion of Key DSRIP Issues" posted below.

The shaded portions of the document reflect the level of detail HHSC plans to include in the draft renewal request that will be posted in July for submission to CMS in Sept. 2015. Many of the other programmatic details discussed in this document will be worked out through amendments to the program protocols, which HHSC will work to submit to CMS in late 2015 - early 2016. HHSC will work with stakeholders in the coming months both on the renewal request and the protocol changes.

Transition Plan for Funding Pools

Per the Texas waiver terms, HHSC must submit a transition plan to CMS by March 31, 2015 based on the experience with the DSRIP pools, actual uncompensated care trends in the state, and investment in value based purchasing or other reform options. HHSC formally submitted the Transition Plan below to CMS on March 24, 2015.