Dear Region 2 Providers & Interested Stakeholders:
In our continued efforts for full transparency, I would like to share the e-mail below, including the [attachment]. This relates to the ongoing discussion between CMS and HHSC as it applies to Texas’ Uncompensated Care (UC) Pool in the 1115 Transformational Waiver.
As additional information becomes available from HHSC and/or CMS, we will share with our regional performing providers and interested stakeholders. Thank you.
Craig S. Kovacevich, MA
We want to make you aware of a call HHSC had with CMS this week to discuss the attached letter CMS sent to Florida on April 14th regarding the future of Florida’s Low Income Pool, which serves a similar purpose to Texas’ Uncompensated Care (UC) Pool in the 1115 Transformation Waiver. CMS requested the call with Texas, and on the call from CMS were Vikki Wachino, Tim Hill, and a representative from their general counsel’s office.
CMS said the purpose of the call was to let Texas know that for future renewal requests for UC pools CMS intends to apply the same three principles laid out in the second to last paragraph of the letter to Florida, which are listed below. (They said they’re reaching out to all states with similar UC pools.)
- First, coverage rather than uncompensated care pools is the best way to secure affordable access to health care for low-income individuals, and uncompensated care pool funding should not pay for costs that would be covered in a Medicaid expansion.
- Second, Medicaid payments should support services provided to Medicaid beneficiaries and low-income uninsured individuals. (CMS noted on the call that this is an acknowledgement that some low-income individuals remain uninsured even with Medicaid expansion.)
- Finally, provider payment rates must be sufficient to promote provider participation and access, and should support plans in managing and coordinating care.
CMS acknowledged that each state and its pool is different, but they want to apply these same principles across all states. Texas’ waiver goes through 9/30/2016 and our renewal request is due 9/30/2015. They said that to inform Texas’ waiver renewal negotiations, they want to understand our UC pool better to establish a framework for negotiation. As they required of Florida, they said they would like us to contract for an independent report to help inform discussions around renewing the UC pool. We asked about our other pool in the waiver – the Delivery System Reform Incentive Payment (DSRIP) pool, and they said that while there will be negotiations and perhaps some overlapping issues around renewing the DSRIP pool, the principles above are intended to be applicable to UC rather than DSRIP.
CMS also acknowledged in the Florida letter that transition time may be required. HHSC plans to continue to work with Texas leadership and waiver stakeholders to submit a renewal proposal to CMS in September 2015 that reflects what Texas wants for the renewal period. We plan to hold a number of public meetings across the state this July to get stakeholder input on the planned renewal request that’s due in September.