It’s called the Texas Healthcare Transformation and Quality Improvement 1115 Waiver, a grandiose name for a far-reaching plan that will help reimburse Texas hospitals for uncompensated care and create an incentive plan to improve services. Blueprints for the new payment systems are being drawn and HHSC is sending out the call to make sure those organizations that will work in the new systems are in on the design phase.
Hospitals and other organizations that want to get funding through the new waiver over the next five years need to get involved with the development process, which is happening now.
According to the rules of the waiver, if a provider does not participate in the regional health care plan development, they will be unable to receive any funds from the Delivery System Reform Incentive Payment (DSRIP) or Uncompensated Care pools during the course of the five-year waiver. HHSC is working with the U.S. Centers for Medicare and Medicaid Services to add flexibility that would allow providers to join later, but HHSC is encouraging interested providers to be engaged now.
As the name suggests, the Uncompensated Care pool will help offset the costs of uncompensated care hospitals and other qualified entities provide to those with Medicaid coverage or to people who cannot pay for care. The DSRIP pool will offer incentive payments to hospitals that develop programs or strategies that enhance access to health care, increase the quality of care or improve the cost-effectiveness of care.
Since the waiver was approved last December, HHSC staff have been touring the state, laying the groundwork for development of regional health care partnerships, which will become the cornerstone for the new hospital payment system. Among those helping with the process are the Texas Organization of Rural and Community Hospitals; the Texas Association of Counties, County Judges and Commissioners Association of Texas; the Texas Hospital Association; and other hospital associations. While developing these regional healthcare partnerships, participants are identifying community needs, proposed projects and funding distribution models. Still in development are final boundaries for each region and designations for each region’s anchoring entity, which is responsible for seeking regional stakeholder input and coordinating development of a regional plan.
Resources for work relating to the Medicaid transformation waiver are online on the HHSC website along with information about upcoming events that will help shape the new payment systems.