Anchor Conference Call AGENDA
Anchor Conference Call AGENDA
April 12, 2013
1:30-3:00 p.m.
Call-in: 877-226-9790
Access Code: 3702236
Anchor Conference Call AGENDA
1. / General Anchor CommunicationHHSC RHP Plan review
· All RHP Plans have been sent to CMS.
· CMS results expected by the end of May for all RHP Plans
DY 1 Payments
· Payment calendar attached for UC and DSRIP.
· DY1 Payment calculations and disbursement process. After RHP Plan submission to CMS, the only change that would occur is if a project is not approved and not replaced
· For DY 1 payments and coordination with IGT entities, Rate Analysis is asking that they NOT submit their IGT to TxNetConnect until they receive direction from HHSC Rate Analysis to do so. If IGT comes too soon, refunds are issued.
· DY 1 DSRIP: For IGT notice, we work to provide info so that IGT entities have 5 days to respond. For the last two regions, this may end up getting condensed to four days.
· We will follow up early next week on any outstanding information needed for DY 1 DSRIP payments.
Program Funding and Mechanics Protocol changes – effective April 4, 2013
Communication has occurred on the changes and the revised PFM is posted on the HHSC waiver website. These changes occurred because CMS was finding they did not have the time and resources needed to do the review that was needed for approval of the projects for all four years.
The following is the message that went out that outlines the primary changes. Additional operational details are below under CMS RHP Plan Review and Results
HHSC has worked with CMS to negotiate revisions to the PFM Protocol to enable initial approval of most DSRIP projects by the end of May 2013.
The changes establish a two-phase CMS approval process: 1) initial approval that is specific to Demonstration Years (DY) 1, 2 & 3, and; 2) full approval specific to DYs 4 & 5. Because of the volume and complexity of Texas’ proposed DSRIP projects (1300+ projects), this phased approval process allows timely initial approval of most projects while allowing CMS additional time to review whether each project’s expected patient impact sufficiently justifies the proposed value for DYs 4 and 5.
HHSC will schedule a webinar for RHP Anchors and providers along with other waiver stakeholders within the next few weeks to further clarify the changes and provide information for RHPs on next steps. The revised PFM Protocol is posted on the Transformation Waiver website. The sections that have changed are sections IV and VII.
The following are the major changes to the PFM Protocol effective April 4, 2013:
· Initial approval will occur for most projects by the end of May 2013. Projects that receive initial approval will be eligible to earn DSRIP payments in demonstration years (DY) 1, 2 & 3. CMS will provide feedback on revisions needed for projects not initially approved. HHSC will work with RHPs and providers to respond to CMS for projects that do not receive initial approval.
· Full approval is specific to DY 4 & 5 and is expected for most projects by September 1, 2013 (and for all projects no later than March 31, 2014), after CMS has more time to review whether the patient benefit of each project supports the proposed project valuation. Full approval will make a project eligible to earn DSRIP payments in DY 4 & 5.
· Each project must have a Category 3 outcome target that complies with a standard methodology, still being negotiated between HHSC and CMS, to be eligible to receive Category 3 payments in DY 4 and 5. This methodology will be established no later than October 1, 2013.
· DSRIP providers will be required to submit semi-annual reports to HHSC on the progress of their projects regardless of whether they have completed metrics for payment.
· There will be a mid-point assessment by the end of DY 3 (September 30, 2014). HHSC will contract with an independent entity to monitor the progress of DSRIP projects and make recommendations for any changes to facilitate the success of a project. CMS and HHSC may require prospective project changes for DY 4 and 5 based on the mid-point assessment if the performance of a project substantially deviates from what was approved.
· The larger RHPs (Tiers 1-3) will be required to conduct regional learning collaboratives to support continuous quality improvement, which is of great interest to CMS. Tier 4 RHPs may have their own regional learning collaborative or participate in another RHP’s collaborative and must participate in the statewide learning collaborative.
Monitoring
· Staff is continuing to work with state leadership and CMS on a monitoring that would occur through an independent entity. A small portion (up to 1%) is under discussion. Expedited rules would be proposed. The monitoring function is included in the PFM revisions.
Learning Collaborative information
· CMS has offered to provide training, possibly via webinar, on learning collaborative, once CMS has completed the 45-day review process for all RHP Plans expected to be completed by the end of May.
· Early next week, we will send out the questions that RHP 17 has compiled and ask other RHPs to submit any additional questions. We will send to CMS for guidance on the learning collaborative plan that is required to submit to CMS by October 1, 2013.
2. / CMS RHP Plan Review and Results
CMS results provided via letter that is sent to HHSC and RHP anchor contact
· RHP 17 CMS review results received and RHP 14 expected today.
· De-identified RHP 17 letter will be provided (attached) so that RHPs can see what to expect in their letter
· Types of status for Category 1 & 2 include the following: Initially approved; initially approved with priority technical corrections addressed; initially approved with adjustment of project value; projects not approved at this time
· Projects not approved at this time for RHP 17 focused on the same types of projects previously communicated: supply sensitive; those that the target population of Medicaid/indigent is not clear, and “other” project that may be able to fit in a standard menu option.
· For valuation adjustments that have been proposed, CMS has stated that they will provide additional information on methodology, and we will share once received; HHSC will also provide information on average value of similar projects. If a provider chooses to reduce the value of a project based on CMS feedback, additional projects cannot be proposed to use the remaining funds.
· For Category 3, other outcomes will likely not be approved at this time until the Category 3 refinement has occurred.
· Patient Satisfaction Outcomes – We are working with CMS on guidance for OD-6, Patient Satisfaction. This will clarify the use of IT-6.1 versus IT-6.2 and the use of supplemental CAHPS modules as outcomes. Depending on the timing, non-hospital providers may submit “TBD” for initial approval.
· If process milestones are included for DY 2 for non-hospital providers for Cat 3, providers can report in the second reporting opportunity after Cat 3 measure has been submitted to CMS (scheduled to occur no later than Oct. 1, 2013.)
· CMS will clarify in the future CMS letters that approval of a Cat 1 or 2 project is required for the related Cat. 3 outcome to be approved.
· CMS will add a general statement in future CMS letters that if a provider has no approved Cat 1 or 2 projects, then their Cat 4 is not approved.
This is Information provided on previous anchor calls on HHSC review
HHSC valuation review
· Upon re-review of projects, some may remain flagged for CMS for valuation if the provider did not include quantifiable patient benefit in the milestones or if a project is an outlier (appears overvalued) based on the milestones and patient scope of the project.
· Some projects like QI/REAL and workforce projects will be noted for CMS since they do not translate as cleanly to demonstrate quantifiable patient benefit.
· HHSC is focusing on higher valued projects (e.g. $5 million for a Tier 4 RHP) when flagging projects for valuation. However, technical review is focused on all projects.
HHSC technical review
· Upon re-review of projects, HHSC will identify all projects with outstanding priority issues, regardless of valuation. These issues may include Category 1 or 2 milestones that duplicate Category 3 improvement targets; core components not addressed; and no outcome improvement target identified by hospital providers.
Process to respond to CMS
· HHSC is developing a companion document to the letter that will outline the process to respond to CMS results
· Two-phase process – Phase 1 for projects not approved at this time, and projects that CMS has proposed an reduced value for initial approval; Phase 2 will include priority technical corrections and Category 3
· HHSC may also identify additional technical corrections needed for clarity in milestones in order to make payment. This will also occur in Phase II
· HHSC will establish a rolling timeline based on the order of the completion of the 45-day review and receipt of the RHP CMS results
The following Anchor Talking Points from March 1, are to be used for submitting replacement projects – a provider can wait until formal CMS feedback before determining whether they want to replace a project:
If a provider chooses to submit a replacement project for a project CMS has indicated they will not likely approve, the provider has the option to propose replacement projects at the same value or less that could be implemented beginning DY 2.
The replacement project has to meet the following requirements:
· Represent an intervention that is in response to community needs identified in the RHP’s needs assessment.
· Given the need for timely review, the project must be on the RHP Planning Protocol DSRIP menu and not an “Other” project option and also not include “Other “Category 3 outcome(s).
· Include milestones that represent implementation activities beginning in DY 3 and not just planning activities.
· Submitted along with a completed DSRIP Feedback Changes Electronic Workbook.
· Replacement projects would also need to undergo review by HHSC and subsequently submitted to CMS. CMS would start a new 45-day clock for the replacement projects separate from the initial RHP Plan submission.
· HHSC will provide a template for project replacement at a later date.
Revisions to RHP Plans
· Now that all RHPs have submitted their plan in response to formal feedback and RHP Plans have been submitted to CMS, providers should not make changes to projects unless at the request of HHSC or CMS. (This includes the project narrative – CMS has emphasized that project narratives are important parts of the plan.)
· When revisions are made, RHPs can work from the clean copy of their plans. Providers will highlight or include strikethroughs for revisions made at the request of HHSC or CMS.
3. / DY 1 DSRIP
We will follow up early next week on any outstanding information needed for DY 1 payments.
DY1 DSRIP
· HHSC is sending each Anchor a list of DY1 DSRIP payments and available IGT based on the RHP Plan submitted to CMS. RHPs may request that HHSC retain a portion of the DY1 DSRIP payment until final CMS approval for potentially risky projects. HHSC will only request the IGT for the partial payment. Delayed DY1 DSRIP will be paid during the scheduled DSRIP payment period following CMS approval, e.g. May DY1 DSRIP payment, September DY2 DSRIP payment, or November DY2 DSRIP payment.
· If a Performing Provider has a pending TPI, HHSC will not pay DY1 DSRIP until a TPI is obtained. HHSC will not request IGT until an active TPI has been established. The last date to obtain a TPI for DY1 DSRIP payment in May is April 17th.
· Rate Analysis will contact the IGT Entity representatives listed in Section I of the RHP Plan to notify them of the timelines and process for submitting IGTs.
Modifications to information in Section I Organization Table to update contact information. If there are contact information changes that may impact notifications for payment, please use following process:
· Modify the existing contact information to include the email address of the new CEO and Director – if it would be helpful to the new leadership in place, also provide a back up email to someone at both facilities that has worked on the RHP Plan and is familiar with the process. They will be able to assist with the transition.
· Send the notification to both the Waiver mailbox at and Rate Analysis Division mailbox at
5. / DY 2 Reporting
DY2 Reporting Format
HHSC is in the process of transferring all milestones and metrics into Excel for DY2 reporting and will verify information with Performing Providers. For the manual DY2 reporting, Performing Providers will use an Excel template to report progress on each metric, e.g. a metric is to draft a plan, the Performing Provider would enter Yes/No for the metric and attach the plan to the ShareFile site that is being set up. ShareFile users will be based on information provided in Section I. of the RHP Plan. HHSC will provide additional information on the template in April.
There are currently two options for the first DY 2 DSRIP reporting – either June or August 2013. If an RHP is planning to use June DY 2 reporting option, please send this information to HHSC Waiver mailbox as soon as possible. All providers in an RHP are required to choose the same option. At this time, if there are not RHPs planning to use the June option, this gives some additional time to refine the Excel template.
6. / Additional Information
DY 3 Project Planning
Funding of DY 3 projects through the plan modification process is under development and a draft for feedback may be completed in May. Expedited rules will be needed which will likely be proposed in June for adoption in September or October.
HHSC Grant that may be of interest
State Innovation Models (SIM)Grant Initiative: Kick-Off Webinar
On Friday, April 19, 2013, at 10 am Central Time, the Texas Health and Human Services Commission (HHSC) and Health Management Associates (HMA) will hold a webinar/conference call to kick-off the State Innovation Models (SIM) initiative. The federal Centers for Medicare & Medicaid Services (CMS) recently selected Texas as one of 25 states to participate in this initiative.
Through this opportunity, HHSC will work with stakeholders to design multi-payer delivery and payment system models for improving the quality and efficiency of health care. Potential options include shared savings arrangements, medical or health homes, bundled payments, or accountable care-type organizations.
This event requires registration. Once a participant has registered, login and call-in instructions will be provided. On the morning of April 19, participants can choose to login online or to only call in.
To be added to the State Innovation Models email distribution list and receive instructions on how to register for the webinar, email
For waiver questions, email waiver staff: .