DY3 Provisional NMI Results and; April DY4 Reporting Update

Dear Region 2 Performing Providers and Stakeholders:

Please see the information below from HHSC.  Thanks.

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The April DY4 DSRIP reporting season is upon us.  Please note the updates below.

October DY3 Provisional NMI Results

  • HHSC has completed the review of provisionally approved metrics that received “Need More Information” (NMI) requests.  HHSC will notify providers today via email with coversheet if a provisionally approved metric was ultimately not approved.  If a provider does not receive notification that a provisionally approved metric was not approved, the provider can assume that all provisionally approved metrics will remain approved.  To be clear, if you do not receive a coversheet from us today, your provisionally reviewed metrics were approved.  For provisionally approved metrics that were not approved, the HHSC Rate Analysis Division will inform the provider of the recoupment amount by mid-April.

April DY4 Reporting Updates

  • The DSRIP Online Reporting system opens April 1st and closes April 30th at 11:59pm CDT.
  • DY4 reporting companions and templates are being uploaded this week. HHSC is posting to the waiver website resources to support April DY4 reporting.  Our goal is for all documents to be uploaded by the end of this week, so please continue to check in.  HHSC strongly encourages providers to review the reporting companions prior to submitting any information into the online reporting system. HHSC has updated the general reporting companion, as well as three topic specific template guides for QPI, Category 3 DY4 performance reporting and Category 4 DY4 performance reporting.  These last three companions (QPI, Cat 3 and Cat 4) are step-by-step instructions for how to populate the respective templates.
  • Upcoming webinars:
  • General Reporting and QPI:  Tuesday, April 7, 2015, 10:00AM – 11:30AM CDT.
  • Category 3 and Category 4 reporting:  Tuesday, April 7, 2015, 2:00PM – 4:00PM CDT.
  • Webinars will be recorded and posted to the waiver website as soon as possible.
  • QPI Update:
    • HHSC will be posting the DY4 QPI Reporting Template on the Waiver website prior to  next week’s webinar.
    • Providers whose projects were very recently in discussion or are still in discussion with HHSC about final changes to the QPI template or QPI metrics will have a delay in having the DY4 QPI template available to them. These providers will need to wait until a revised template is available and issues are resolved before beginning to report on the project(s) in question.
    • In a limited number of cases, if QPI issues require further technical assistance, the provider will need to wait until the October reporting period before reporting achievement for the QPI metric.
    • HHSC will share the list of affected projects prior to when the DY4 QPI template is posted.
    • For projects that are not on the list of delayed projects, if an issue is raised by the provider or  identified by HHSC or the compliance monitor before April DY4 reporting closes, reporting may need to be delayed until October DY4 reporting.
  • Category 3 TA Status Updates: HHSC staff reviewed all baselines reported in DY3 and identified which of these baselines required technical assistance (TA).  HHSC prioritized those outcomes that would be eligible to report in April of DY4, which is determined by the baseline measurement period reported by providers.  We will continue to provide baseline TA to those providers that are eligible to report outcomes in October of DY4 over the next couple of months.  To that end, HHSC staff will be sending a regional TA status to anchors this week.   This status will identify which projects are eligible to report in April vs October DY4 and which of the outcomes have remaining TA concerns.  This eligibility to report at the Category 3 project level will also be contained within the DY4 Performance Reporting template.  Please attend the Category 3 webinar (detailed above) for additional information.
  • Category 4 Update:
    • HHSC is attaching a summary of Cat 4 project Reporting Domains that are eligible for reporting in April DY4 based on their measurement period. DY4 measurement periods are set as the 12-month measurement period immediately following the measurement period selected for DY3 reporting. RDs with a DY4 measurement period ending by 03/31/2015 may report in either April or October DY4. RDs with a DY4 measurement period that ends between 03/31/2015 and 09/30/2015 will be eligible for October DY4 reporting only. For RDs 1-3, the DY4 measurement period is 01/01/2013 – 12/31/2013 and all RDs 1- 3 are eligible to report in April.
    • HHSC will be sending out PPA, PPR, and PPC reports the first week in April. Most providers will be receiving all three reports. Providers with very low volume may receive fewer than 3 reports. All providers will be required to answer qualitative questions for RDs 1-3 in DY4, regardless of volume.
    • The Category 4 template has changed slightly from DY3. Please attend the Category 3 and Category 4 webinar for detailed instructions on reporting Category 4 in DY4.
  • Changes Related to Mid-Point Assessment:  If HHSC has notified a provider or anchor by COB on April 1 that certain DY4 metrics will change as a result of the mid-point assessment, the provider should wait to report on the related metric(s) until HHSC notifies the provider that the required changes have been made.  The changes are expected to be complete by the end of this week.

Please email the waiver mailbox if you have any questions: txhealthcaretransformation@hhsc.state.tx.us

 

1115 Waiver Updates: Anchor Notes and Estimated DY4 IGT Commitments

Dear Region 2 Performing Providers and Stakeholders,

Please see the attached information re: [anchor notes] from March 10, 2015 and the file with the estimated [DY4 IGT commitments].

You will notice an item in the notes that HHSC recently discussed the draft transition plan for the two pools (UC & DSRIP) with CMS in advance of the formal submission (by March 31, 2015).  I anticipate being able to send a more detailed update soon.

If you have any questions, please do not hesitate to contact me personally.
Thank you,
Craig

1115 Waiver Success Story: Baptist Hospitals of Southeast Texas’ SMART Health Clinic/Patient Navigation DSRIP

Dear Region 2:

 

If anyone would ask me if I like my job, I would have to say, “No!”  Why would I say such a thing?  Because, I would be lying if I didn’t say, “I LOVE my job!”  While keeping up with the technicalities of the 1115 Healthcare Transformation Waiver can be rather arduous at times and the reporting process somewhat grueling, the benefits and outcomes of the waiver projects are truly beginning to positively impact healthcare delivery for many of our region’s most vulnerable individuals.  And, I also LOVE my job because of the people in the region that my team and I support each and every day in our role as anchor–dedicated providers and community stakeholders who are eager to work together to find innovative solutions to real, concrete needs.  And, rightfully so.

 

Of the nearly 1.5 million individuals residing within the 16-counties that comprise Region 2, 25% of the population is uninsured and another 27% are Medicaid or Medicaid/Medicare (dual eligible) recipients.  The region covers some 14,500 square miles, and much of its densely rural areas are often referred to as “Deep East Texas.”  While a large portion of Region 2 is widely known for picturesque images of tall Pines, blooming Dogwood trees and freshwater lakes, the fact remains that more than 50% of the geography is designated as a Health Professional Shortage Area in primary care and mental health services.  These statistics amplify the importance of waiver projects and reconfirms why performing providers within our Regional Health Partnership continue to be focused on executing well-defined, purposefully-crafted, measurable outcomes.

 

In traveling extensively through the region since the inception of the waiver, many similar themes have surfaced.  Regardless if visiting with providers practicing in more populous counties, like Galveston or Jefferson, or trying to understand challenges from practitioners in more rural parts, like Angelina or San Augustine County, the need for better coordinated healthcare is always at the top of the “wish list.”  One might think that coordinating care for people with complex, chronic conditions isn’t as difficult of a process in more metropolitan markets; but, while admittedly easier, coordination is only as successful as the system put in place.  This was one of the most obvious opportunities identified in the comprehensive Region 2 Community Needs Assessment, and a key strategic focus for many regional providers like Beaumont-based, Baptist Hospitals of Southeast Texas.  During the planning process, Baptist leadership quickly committed to utilizing the waiver as a means to identify, evaluate, prioritize various processes to help their most at-risk patients better navigate the healthcare system.  Part of this commitment was to hire, train and deploy patient navigators: individuals who are knowledgeable about the community and its resources, sensitive to the cultural diversity of the individuals they support and capable of shepherding patients throughout the continuum of care.  As a result of Baptist’s foresight to the improvement of clinical outcomes through better coordinated care, and, by their support of the 1115 Healthcare Transformation Waiver, two (2) Delivery System Reform Incentive Payment (DSRIP) projects were designed to turn the vision into reality.  Within the projects, a variety of milestones and metrics were carefully crafted over a four-year period, including measures to educate and encourage targeted patients to properly utilize the appropriate healthcare channels (right care, right place, right time).  As reported in the Beaumont Enterprise in November 2014 (http://www.beaumontenterprise.com/news/article/Local-navigators-steer-patients-toward-better-5920009.php#photo-7196542), individuals like Anthony Joseph, a Baptist Beaumont patient and triple-bypass survivor, have benefited from the waiver through the creation of the Baptist Smart Health Clinic and the Baptist Patient Navigation Program, both of which emphasize patient-centered care.  

So, I am proud to report that it’s stories like this that provide a tangible look at the impact the waiver is making in our region and across the state each and every day.   And, furthermore, it’s stories like this that make me say, “I LOVE my job!”

Thank you,
Craig

1115 Waiver Success Story: A DSRIP Project to Enhance Interpretation Services and Culturally Competent Care

[Attached] is an article that I am extremely proud to share with performing providers and interested stakeholders within Region 2.  It showcases one of many successful DSRIP projects under the 1115 Medicaid Waiver within the 16-counties that comprise our region.  As you will read, The University of Texas Medical Branch (UTMB) Patient Services Department made its initial purchase of iPads in April 2014 and began Video Remote Interpretation (VRI) services in designated units throughout the hospital.  This new service was one component of the DSRIP project designed to “enhance interpretation services and culturally competent care” at UTMB.  It utilizes the tablets to offer patients on-demand video language interpretation services with a live person.  According to Martha Livanec, Director of Patient Services, “Language interpretation services are vital to patient safety.”  Livanec also notes, “If a patient doesn’t understand what is going on with their condition because of a language barrier, they and their family members can’t make informed decisions about their care.”  Since the VRI tablets were introduced, they have assisted UTMB’s Patient Services staff to ensure that patients who require an interpreter have access to services even when staff and/or department interpreters cannot be present in person. 

In addition to the great outcomes (to date) and the overwhelming support of this project from UTMB providers, staff members and patients, Ms. Livanec’s VRI project was selected to be highlighted at the National Patient Safety Foundation’s (NPSF) Annual Patient Safety Congress in late April via a poster presentation.  With the assistance of Susan Seidensticker, Director of Waiver Quality Operations for the Region 2 Anchor Office, a national audience will be able to see the impact of translation services to patient safety.  Seidensticker said, “Presenting on this topic at an event like the NPSF Congress is not only an excellent opportunity for UTMB to share how effective communication directly impacts good clinical outcomes; but, how the Texas waiver helped make this projects and other transformational opportunities possible.”   

On behalf of Katrina Lambrecht, JD, MBA, Vice President, Institutional Strategic Initiatives, and the entire Anchor Office team, I would like to congratulate both Ms. Livanec and Seidensticker.  They also join me in requesting that performing providers within Region 2 share/submit success stories related to their DSRIP project(s).  As HHSC leadership works with CMS to negotiate a (possible) waiver renewal or extension, stories like the one highlighted above help illustrate the value of the waiver in Texas and demonstrate that the tremendous work being done through the 1,491 active DSRIP projects supports the Triple-Aim of healthcare: improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care. 

Thank you,
Craig

CMS letter lifting the UC deferral

Dear RHP 2 1115 Waiver Stakeholders –

Yesterday, HHSC received the [attached] letter from CMS that formally removes the UC deferral issued in September 2014.  As we anticipated, the letter notes that CMS plans to work with Texas to do further analysis related to its concerns around private hospital IGT financing arrangements.  As outlined in the letter, if CMS determines that any of the financing arrangements violate federal law and/or any regulations, they expect that Texas would  make necessary adjustments by December 2015.

My office will continue to keep you updated on this issue as we are apprised of new developments by HHSC or other sources. 

Thank you,
Craig

Mar 31

DY3 Provisional NMI Results and; April DY4 Reporting Update

Dear Region 2 Performing Providers and Stakeholders: Please see the information below from HHSC.  Thanks. ******************************* The April DY4 DSRIP reporting season is upon us.  Please note the updates below. October DY3 Provisional NMI Results HHSC has completed the review of provisionally approved metrics that received “Need More Information” (NMI) requests.  HHSC will notify providers …

Continue reading »

Permanent link to this article: http://blogs.utmb.edu/1115/2015/03/31/dy3-provisional-nmi-results-april-dy4-reporting-update/

Mar 17

1115 Waiver Updates: Anchor Notes and Estimated DY4 IGT Commitments

Dear Region 2 Performing Providers and Stakeholders, Please see the attached information re: [anchor notes] from March 10, 2015 and the file with the estimated [DY4 IGT commitments]. You will notice an item in the notes that HHSC recently discussed the draft transition plan for the two pools (UC & DSRIP) with CMS in advance of …

Continue reading »

Permanent link to this article: http://blogs.utmb.edu/1115/2015/03/17/1115-waiver-updates-anchor-notes-estimated-dy4-igt-commitments/

Feb 17

1115 Waiver Success Story: Baptist Hospitals of Southeast Texas’ SMART Health Clinic/Patient Navigation DSRIP

Dear Region 2:   If anyone would ask me if I like my job, I would have to say, “No!”  Why would I say such a thing?  Because, I would be lying if I didn’t say, “I LOVE my job!”  While keeping up with the technicalities of the 1115 Healthcare Transformation Waiver can be rather …

Continue reading »

Permanent link to this article: http://blogs.utmb.edu/1115/2015/02/17/1115-waiver-success-story-baptist-hospitals-of-southeast-texas-smart-health-clinicpatient-navigation-dsrip/

Feb 10

1115 Waiver Success Story: A DSRIP Project to Enhance Interpretation Services and Culturally Competent Care

[Attached] is an article that I am extremely proud to share with performing providers and interested stakeholders within Region 2.  It showcases one of many successful DSRIP projects under the 1115 Medicaid Waiver within the 16-counties that comprise our region.  As you will read, The University of Texas Medical Branch (UTMB) Patient Services Department made its …

Continue reading »

Permanent link to this article: http://blogs.utmb.edu/1115/2015/02/10/1115-waiver-success-story-a-dsrip-project-to-enhance-interpretation-services-and-culturally-competent-care/

Jan 14

CMS letter lifting the UC deferral

Dear RHP 2 1115 Waiver Stakeholders – Yesterday, HHSC received the [attached] letter from CMS that formally removes the UC deferral issued in September 2014.  As we anticipated, the letter notes that CMS plans to work with Texas to do further analysis related to its concerns around private hospital IGT financing arrangements.  As outlined in …

Continue reading »

Permanent link to this article: http://blogs.utmb.edu/1115/2015/01/14/cms-letter-lifting-the-uc-deferral/

Dec 22

1115 Waiver Update: RHP level PPA and PPR Now Available

RHP 2: RHP level PPA and PPR data is now available for download and review on the HHSC Waiver website (http://www.hhsc.state.tx.us/1115-Waiver-Guideline.shtml.) This is Medicaid/CHIP data from calendar year 2012, along with a descriptive summary document.   On behalf of the UTMB/RHP 2 Anchor Office team, we want to wish you much peace and joy during …

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Permanent link to this article: http://blogs.utmb.edu/1115/2014/12/22/1115-waiver-update-rhp-level-ppa-and-ppr-now-available/

Dec 22

RHP 2 -January 2015 – Important Upcoming Dates and Deadlines

Given the approaching holidays, I wanted to share a quick snapshot of upcoming dates and deadlines for January 2015.  Please feel free to share with others in your organization who may be responsible for certain aspects of the 1115 Waiver.  January 2015 – Important Upcoming Dates and Deadlines January 1 – IGT Entity Change Form …

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Permanent link to this article: http://blogs.utmb.edu/1115/2014/12/22/rhp-2-january-2015-important-upcoming-dates-and-deadlines/

Dec 16

Waiver Updates and Important Information – Region 2

Dear Region 2: Thank you to our amazing and dedicated performing providers in Region 2 who collectively submitted $71,600,633 (total value) for metric achievement during the recent DY3 October Reporting Period.  169 of the 243 total submitted metrics were “approved,” with 59 “provisionally approved” and 15 flagged for “Needs More Information.”   Please see additional details …

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Permanent link to this article: http://blogs.utmb.edu/1115/2014/12/16/waiver-updates-and-important-information-region-2/

Dec 16

Update on UC Deferral

Transformation Waiver Stakeholders – We want to give you a brief update on the September UC deferral.  HHSC expects to receive from CMS next week the letter formalizing the lifting of the deferral.  This is very encouraging, and we want to thank those of you that helped get the deferral lifted by providing supporting documentation …

Continue reading »

Permanent link to this article: http://blogs.utmb.edu/1115/2014/12/16/update-on-uc-deferral/

Dec 15

RHP 2 Regional Meeting Information-December 3, 2014

Below is the link to review the information and attachments from RHP 2’s Regional Meeting on Wednesday, December 3, 2014.  https://ispace.utmb.edu/xythoswfs/webview/_xy-8665668_1  

Permanent link to this article: http://blogs.utmb.edu/1115/2014/12/15/rhp-2-regional-meeting-information-december-3-2014/

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