Bobbie Guyton

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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.


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Dec 10

1115 Waiver – 12/05/14 Anchor Update

October Reporting and Review

  • HHSC will complete its review by Dec. 8.  Providers will be able to login to the DSRIP Online Reporting System to view the HHSC Signoff and HHSC Comments for each metric.  HHSC will also send summary information to anchors and providers during the week of December 8 with the signoff status of each metric.
  • For metrics marked “Need More Information,” providers will have until 11:59 p.m. on Friday, January 16, to submit additional information using the Online Reporting System.  HHSC will provide additional instructions with the summary information next week.
  • For metrics that were approved in the current round, or approved but unpaid in previous rounds, IGT will be due from IGT entities on Monday, January 5, and payments will occur on January 30. HHSC Rate Analysis will send out the IGT due based on our review the week of Dec. 15th using FMAP of 58.05.
  • As noted previously, language has been added to the Program Funding and Mechanics Protocol (PFM) to specify that HHSC and CMS may determine that a subset of not less than half of the projects and metrics will be reviewed during the 30 days after a reporting period.  In such instances, HHSC and CMS will designate those projects and metrics that are not reviewed within 30 days as “provisionally approved.”  Such “provisionally approved” projects and metrics will be reviewed in full by HHSC prior to the next reporting due date in April 2015.
  • For metrics that are “provisionally approved,” the HHSC Signoff will show “Approved,” but the HHSC Comment will indicate that the approval was provisional.  The Performing Provider is eligible for full DSRIP payment for these metrics in January, and the IGT for these metrics will be included in the request for IGT that is due on January 5.  After review of any “provisionally approved” metrics, HHSC will request additional information if necessary, most likely in late February or early March 2015.  If the initial supporting documentation, and any additional information, does not form a sufficient basis for actual metric achievement, HHSC will recoup the associated overpayments from the Performing Provider.  As described in waiver rules, HHSC will withhold future payments until the recoupment occurs.
  • Some providers have asked about the “Achievement Value” shown under each metric in the Online Reporting System.  Please note that the achievement value shows 100% only after the HHSC signoff shows “Approved.”  During previous reporting periods, the reporting templates showed an achievement value of 100% when the provider reported “Yes-Completed” for the metric.

 Change Requests

  • Just a reminder that the responses to the change request NMIs are due to HHSC by Tuesday, December 9Responses are due to the Anchor by Monday, December 8th at 10 AM
  • Providers have submitted a number of QPI-related change request questions to the Transformation Waiver mailbox.  Please remind them that detailed information regarding how to calculate pre-DSRIP baseline and QPI goals is included in the October DY3 Quantifiable Patient Impact (QPI) Reporting Companion Document available on the Transformation Waiver website at

 Mid-point Assessment

  • The schedule for onsite visits and entrance conferences for the remaining regions has not changed significantly since our last update (see below for most recent schedule). Myers and Stauffer will be contacting regions to schedule these.

o   Week of December 8th: RHPs 4 and 5

o   Week of December 15th : RHPs 2

o   Week of January 5th: RHPs 3,7,9,10,12,14 and 15 (tentative)

o   Week of January 19th: RHP 6 (tentative- may be contacted earlier in January)

Amanda Broden

Healthcare Transformation Waiver Operations


Texas Health and Human Services Commission

(512) 462-6388


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Dec 10

RHP 2 – Mid-Point Assessment Update

Dear RHP 2:

As you know, Mid-Point Assessments of DSRIP waiver projects in Texas are actively being done.  As part of this assessment, Myers and Stauffer are conducting site visits of selected providers in each RHP on behalf of CMS as well as visiting with anchoring entities.  Region 2 is scheduled for next week.  Given that the auditors are doing much of our region via desk reviews, they will have a very limited scope in Region 2 for on-site visits; therefore, we will not host a meeting with the Myers and Stauffer staff with the region as previously anticipated.  The anchor team will host the Myers and Stauffer team in Galveston to discuss our role within the region and also answer any questions they might have.  The audit team will then visit independently with any organization(s) they identify.

If you have been identified for an on-site (in-person) visit, you should have received notification by today.  If you have not received such notification, you will not have Myers and Stauffer staff on-site (in-person) next week.   

If anything changes, we will advise the region; however, we anticipate this Mid-Point Assessment to be a smooth process based on discussions with other regional anchors and providers in the state.

Thank you,

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Dec 02

IMPORTANT UPDATE: HHSC announces that CMS Plans on Lifting UC “Deferral” in Texas

Dear Region 2 Providers:

Many of you may have already seen the HHSC announcement below related to the ongoing UC “deferral” issue in Texas ; but, just in case you did not, I wanted to share Lisa Kirsch’s note sent to anchors yesterday evening.  Based on the communication below, CMS told HHSC that they are lifting the “deferral,” and will send notice to that effect in the next week or two.  Lifting of the “deferral” will ensure that upcoming UC and DSRIP payments made during the upcoming year will not be subject to “deferral” or “disallowance” based on the financing concerns raised in the UC deferral letter.  The communication further indicates that CMS and HHSC plan to work over the coming year to address CMS’ concerns.

Please feel free to share this e-mail with anyone in your organization who might be interested as well as your IGT sources, if external.

Also, I look forward to seeing those of you who plan to attend the Region 2 1115 Waiver Meeting and DSRIP Reporting/Achievement Celebration tomorrow, Wednesday, December 3, 2014.  If you have not yet sent in your RSVP, please do so immediately if you can join us from 10 am to 1 pm in Galveston on UTMB’s Main Campus.  Please e-mail Bobbie Guyton at or call 409-766-4045 for more details, including dial-in instructions for remote participation.

Thank you,

1115 Waiver Stakeholders –

As you know, IGT for a December UC payment is due to HHSC by this Friday, December 5th. HHSC has been working diligently with the Centers for Medicare and Medicaid Services (CMS) to get the deferral lifted, and on a phone call with CMS Central Office and Regional Office this morning we learned that CMS plans to lift the current UC deferral and work with HHSC and Texas stakeholders in the coming year to understand and resolve concerns CMS has regarding Texas’ financing arrangements for supplemental payments to private hospitals. HHSC expects to get a letter from CMS within the next 1-2 weeks with written confirmation that the deferral will be lifted to afford the State and CMS time to work to resolve CMS’ concerns.  Based on today’s call, HHSC’s understanding is that UC and DSRIP payments made during the upcoming year will not be subject to deferral or disallowance based on the financing concerns raised in the UC deferral letter.

We’ll keep you posted as we know more.

Lisa Kirsch
Chief Deputy Medicaid/CHIP Director for Policy and the Transformation Waiver
Texas Health and Human Services Commission


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Nov 10

Anchor Call Notes-November 7, 2014

[Attached] are the notes from the Anchor Call on Friday, November 7, 2014 along with the [STC 48 (Pool Transition Plan) document] discussed with EWC this week.

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Nov 10

HHSC 10/31 letter to CMS Re: UC deferral

Dear RHP2 Performing Providers and Stakeholders:

For your reference, [attached] is a letter that Texas’ Medicaid Director Kay Ghahremani sent to Cindy Mann at CMS on October 31st in advance of HHSC’s November 3rd meeting with CMS related to the UC deferral. HHSC is working to provide CMS the remaining requested documents and we’ll provide you an update next Friday on next steps.
Thanks, Craig.

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Nov 07

REGION 2 UPDATE: DSRIP 1115 Waiver Renewal Survey due 11/26/14

Dear Region 2 Performing Providers and Stakeholders:

You may have received the message below and link to the HHSC waiver renewal survey earlier this week from HHSC.  However, I am sharing once again because it is very important for HHSC to hear from providers/stakeholders, like you.  I strongly encourage you to take a few minutes and participate in the survey which closes on November 26, 2014. 

To access the survey, click on the following link:  Once you have completed the survey, click the “submit” button at the end of the survey to submit your responses.  Again, the survey will be available until November 26, 2014

On behalf of HHSC and the Region 2 Waiver Office, thank you in advance for your participation.



Texas’ 1115 demonstration waiver, the Healthcare Transformation and Quality Improvement Program, is a 5-year waiver that goes through September 30, 2016. It includes Texas’ two major Medicaid managed care programs (STAR and STAR+PLUS), children’s dental managed care, an Uncompensated Care (UC) Pool and a Delivery System Reform Incentive Payment (DSRIP) Pool. In order for Texas to continue these Medicaid managed care programs, UC, and DSRIP, Texas must submit a renewal or extension request no later than September 30, 2015.  This survey is specific to DSRIP.

HHSC seeks input from Texas Medicaid stakeholders, including both current Regional Healthcare Partnership (RHP) participants and other interested entities, on the future of the DSRIP program as Texas begins to pull together the renewal/extension (hereafter referred to renewal) request.  HHSC will use this information to help inform an initial plan for the waiver renewal request.

In submitting your responses, please consider the following:


  • DSRIP is a substantial federal investment – Texas needs to demonstrate the value of the investment.
  • The need to continue to strengthen care coordination among providers across the continuum of care.
  • Outcomes measurement is important – consider some funding for shared outcomes at the RHP and/or State level?
  • Sustainability going forward – how to take what’s being learned through DSRIP, sustain/disseminate/replicate best practices, and embed these practices into everyday Medicaid business?
  • Texas is at the forefront of DSRIP renewal (California is a year ahead of Texas) – so think what the next phase of DSRIP could look like to build on what we’ve learned so far.

To access the survey, click on the following link:  Once you have completed the survey, click the “Submit” button at the end of the survey to submit your responses.  The survey will be available until 11/26/2014.


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Oct 27

Anchor Call Notes 10/24/14

Dear RHP 2 Performing Providers and Stakeholders:
Attached are the anchor call notes from the call hosted by HHSC on Friday, October 24th.

[Anchor Notes]

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Oct 22

UPDATE: Talking Points from HHSC on CMS UC Deferral Letter

Good Afternoon Region 2:

In an effort of full transparency, I am sharing with RHP 2 Performing Providers (and those stakeholders who have requested such communication) the following update from HHSC regarding the ongoing Uncompensated Care (UC) review.  As previously announced, CMS has stated it will “defer” federal funds for Uncompensated (UC) payments for private hospitals that are in certain funding arrangements that CMS believes may be unallowable uses of provider-related donations.  More details can be found on the HHSC website and in the letter I published for RHP 2 on Tuesday, October 7, 2014 (

The information below from HHSC was shared with anchors and other parties on Friday, October 17, 2014 in advance of a UC update call hosted by Ms. Pam McDonald, Director, HHSC Rate Analysis and other key HHSC staff members from both Rate Analysis and the 1115 Waiver team.  This, once again, supplements prior information covered in my above-mentioned communication from Tuesday, October 7, 2014 as well as any prior communication from the State on/before Friday, October 17, 2014.  
At this point, we have not learned of any impact to DY3 October Reporting due to the ongoing UC issue.  As such, Performing Providers should continue their plans to submit their reporting tool to HHSC on/before the (extended) deadline of Wednesday, November 5, 2014 at 11:59 p.m.

As we learn more, we will share with our regional providers and interested stakeholders.  If you have additional questions or require further assistance, please contact me personally at: or 409.766.4047.
Thanks you,


Uncompensated Care (UC) Deferral Issue – Talking Points

 HHSC Hosted Call:

Friday, October 17, 2014, 1:00 PM CST


  1. Removal of 8 private hospitals and 1 public hospital from the deferral list and reduction of deferral by $11.7M FF.


Baylor Medical Center at Waxahachie
Scott & White Hospital – Llano
Scott & White Healthcare- Round Rock
CHCA Bayshore LP dba Bayshore Medical Center
Christus Health ARK-LA-TEX dba Christus St. Michae
CHRISTUS St. Catherine Hospital
Christus Health Gulf Coast dba Christus St. John H
Christus Health Southeast Texas dba Christus St. E
Lavaca Medical Center


  1. HHSC meeting this week with attorneys/consultant representing many of the entities involved with the 501s, discussion of strategy, agreement to share information, etc.  Strategy could include:
  2. Prove there were no donations
  3. Provide documentation proving everything was disclosed to and recognized by CMS in 2008
  4. Equity/Access-to-care argument
  5. Face-to-face meeting with Cindy Mann
  6. Contacts from Texas Legislative delegation, state legislators with ties to the Obama administration, etc.


  1. Individual meetings/calls with various impacted entities to gather info requested by CMS.


  1. Working on request to CMS for:
  2. Identities of individuals representing to CMS that public entities would not provide IGTs for private entities if private entity had not provided payment to public entity or 501 and notes of these statements.
  3. Explanation of how HHSC can adequately address CMS’s concern that entities were not forthcoming with documents.  What documents or evidence must HHSC obtain from providers if those providers have no relationship with the questioned 501 or no documents exist?
  4. List of documentation HHSC must provide to ensure that waiver supplemental payments continue without future threat of deferral or disallowance.


  1. HHSC staff briefing with HHSC leadership next week to present strategy for feedback and approval.




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Oct 13

RHP 2 Conference Call-HHSC Updates-Monday, October 13

RHP 2 Providers and Stakeholders:

If possible, plan to join us for a brief conference call on Monday, October 13, 2014 at 1:00 pm (details below).  We will cover updates received from HHSC’s anchor call today.

 Date:                    Monday, October 13, 2014

Time:                    1:00-1:30 pm

Dial:                      1.877.226.9790

Access Code:      3020674

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