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Waiver Renewal

The Texas 1115 Medicaid Transformation Waiver is a five year waiver expiring on September 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 September 30, 2015.

On August 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 August 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.

HHSC Letter to CMS about 1115 Waiver Extension (PDF) (posted 8/23/16)

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).

The document below contains draft questions proposed by HHSC for DY6 core component reporting milestone reporting.  Please submit any questions or feedback regarding these draft questions to by July 22, 2016.  Please include in the subject line: "Core Component Milestone Reporting Questions Feedback."

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.

Updated Transformational Extension Protocol (Menu) with Best Practices/Models (PDF) (1/26/16)

Texas DSRIP Transition Year (DY6) Proposal Submitted to CMS (11/17/15)

Summary of the Transformational Extension Protocol (Menu) for Replacement

Projects - HHSC Proposal (PDF) (9/4/15)

DSRIP Extension Planning and Protocols Webinar (PDF) (posted 9/30/15)

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

1115 Extension Application Draft (7/2/15)

Attachment A - Texas DSRIP Projects (7/2/15)

Attachment B - Quality Monitoring Reports and Deliverables (7/2/15)

Attachment C - Performance Indicator Dashboards and Pay-for-Quality Measures (7/2/15)

Attachment D - 1115 Waiver Extension Budget Neutrality Calculations (7/2/15)

Attachment E - STC Compliance (7/2/15)

Public Notice (7/2/15)

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.

Summary of Comments from Public Meetings on 1115 Waiver Extension (PDF) (posted 8/7/15)

Meeting Dates and Locations

  • Houston
    July 13, 2015 10:00 AM - 12:00 PM CDT
    Texas Department of Transportation
    7600 Washington
    Houston, TX  77007
  • Edinburg
    July 15, 2015 1:00 PM - 3:00 PM CDT
    Edinburg Conference Center at Renaissance
    118 Paseo Del Prado
    Edinburg, TX 78539
  • Tyler
    July 16, 2015 10:00 AM - 12:00 PM CDT
    Tyler Junior College West Campus
    1530 SSW Loop 323, Room 104 
    Tyler, TX 75701
  • Austin
    July 16, 2015 2:00 PM - 4:00 PM CDT
    Texas Health and Human Services Commission, Brown-Heatly Public Hearing Room
    4900 N. Lamar
    Austin, TX 78751
  • San Antonio
    July 20, 2015 9:00 AM - 11:00 AM CDT
    Omni Colonnade
    9821 Colonnade Blvd.
    San Antonio, TX 78230
  • Dallas/Ft. Worth
    July 21, 2015 10:00 AM - 12:00 PM CDT
    Old Red Museum of Dallas County History and Culture
    100 S. Houston St.
    Dallas, TX 75202
  • El Paso
    July 22, 2015 1:30 PM - 3:30 PM MDT
    El Paso First Health Plans, Inc.
    1145 Westmoreland Dr.
    El Paso, TX 79925
  • Amarillo
    July 24, 2015 1:00 PM - 3:00 PM CDT
    Region 16 Educational Services Center, Lecture Hall
    5800 Bell St.
    Amarillo, TX 79109
  • HHSC will also hold a web-based public meeting on July 23, 2015 from 9:30 AM - 11:30 AM CDT To join the online meeting:
    1) Go to Join WebEx meeting
    2) Click on Attend Meeting
    3) Enter Meeting Number: 737 370 214
    4) Call 866-430-8535

The webinar link and call-in number will not be active until approximately 15 minutes before the webinar begins.  It is not possible or necessary to register for the webinar in advance.

To join the audio conference only: All participants should dial 866-430-8535 (no password necessary). You will be placed directly into the audio conference.

HHSC staff from DSRIP, Program Operations (managed care) and Rate Analysis will be present at the public hearings to give a brief presentation of the key components of the waiver renewal packet, and HHSC's role at the hearings will be to take public comments on the waiver renewal. HHSC does not plan to answer questions beyond those requesting basic clarification at the public hearings. Instead, HHSC will record substantive questions about the renewal proposal at each hearing and post answers to these questions on the HHSC website.

People requiring Americans with Disabilities Act accommodation, auxiliary aids or services should call Micah Erwin (512) 424-6549 at least 72 hours before the meeting so appropriate arrangements can be made.

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 September 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.

Waiver Renewal - Discussion of Key DSRIP Issues (PDF)

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.

Transition Plan for Funding Pools (PDF)

Transition Plan Attachment (PDF)