Category: Updated Documents

Feb 28

1115 Waiver – New Regional Information Document for RHP 2

Dear Region 2 Performing Providers & Stakeholders:

Attached is a document that was created to assist you in better understanding the make-up of RHP 2. You will notice the addition of new performing providers who were recently added for Demonstration Years 7-11. This document also provides a high-level overview of the Texas 1115 Waiver, including information on the new concept moving from project to system-wide transformation. Hopefully this general information sheet will be useful as you discuss the Waiver with team members and other interested parties. We will periodically edit/update as new information becomes available, as well as when regional plan details are confirmed.

Thank you for your continued work to help transform healthcare delivery throughout the 16-counties comprising RHP 2.

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Sep 23

Behavioral Health Learning Collaborative on 9/15/2016

Good Morning RHP 2,

Thank you to those who attended the September 15, 2016 Behavioral Learning Collaborative.  The cause and effect diagram related to Care Transitions has been updated per the discussions at the meeting. Documentation needed for reporting Learning Collaborative attendance is below:



Susan Seidensticker, BSIE, MSHAI, CPHQ, CSSBB, PMP
Director, Waiver Quality Operations
University of Texas Medical Branch (UTMB)

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Jun 14

DSRIP Anchor Update for the week ending June 10, 2016

Good afternoon Region 2,

Please see the two attached documents [TexasTransitionYear_PFM_060816.pdf and Additional Operational Details for Cat 3 in DY6.docx] received from HHSC regarding the DY6 transition year.  Please note that HHSC is asking for feedback by Friday, June 17th.

New information that is of special note within the PDF file:

  • On page 2: the introduction of DY6A and DY6B to represent the 15-month transition year.  From an operational (metric) standpoint, HHSC plans to consider DY6B as DY7 metrics, but the details behind those deliverables are still to be determined.
  • On page 4: Category 4 funding, for those currently participating, will remain the same UNLESS it represents more than 10% of your DSRIP valuation. If it does represent more than 10%, for DY6A it will be capped at 10% and the overage will be reallocated evenly across all of your Category 3s.
  • On page 7: a new inclusion to the projects eligible for a DY6 MLIU QPI goal adjustment; the language added is vague (“any other DSRIP project that HHSC determines has a strong justification for an adjustment”).
  • On page 8:
    • Added language to account for providers who did not document health insurance coverage or financial status prior to the start of DY5.
    • Added the potential of a Project Level Evaluation under possible activities for DY6A Category 1/2 Sustainability Planning (non-QPI) metrics.
    • Refined language around DY6 Category 3.  Please also see the attached Word file for additional information on the option to adjust the 12-month timeframe used for reporting when reporting the DY6 (PY3) achievement.
  • On page 9: continuation of Category 3.  Please note that:
    • The new language for those projects with DY5 Stretch Activities or Maintenance metric requirements.
    • HHSC plans to issue either a revised file or a calculation template for determining the new DY6 (PY3) targets, including clarification for those projects where baseline fell below the minimum performance level.
    • The updated language on PY3 achievement calculations, which will be based off PY1 goal rather than Baseline.
  • On page 10:
    • For those Category 4 participating organizations that are reporting RD6, that will be removed in DY6. Funds associated with RD6 will be evenly spread across RDs 1-5.
    • Confirms that UC only hospitals will again participate in at least one learning collaborative event in DY6.
  • On page 12: MSLC reviews will continue.


You will also see on page 12 information regarding DY6 learning collaborative planning, community needs and stakeholder engagement.  All of this will be discussed further at our upcoming Regional meeting, which will be on the campus of UTMB in Galveston on Friday, July 8th.  If you have not already done so, please RSVP to Bobbie Guyton ( by COB on Wednesday, June 29th so that we can assure that we have our room configured correctly and have an accurate headcount for catering.  The meeting is scheduled to run from 9:30 am-1:15 pm (lunch provided), with optional breakout sessions and a tour of the new Jennie Sealy Hospital building available in the afternoon.


Craig S. Kovacevich, MA
Associate Vice President,
Waiver Operations &
Community Health Plans
UTMB Health
409.766.4047 (Office)

1115 Medicaid Waiver – RHP 2
UTMB HealthCare Systems
UTMB Community Health Plans


Thanks very much for your flexibility to have the call today. Please let us know by 3 pm next Friday, June 17, if there are any major concerns about the PFM.

Attached are some additional details on Category 3. The rules are in the final stages and we will also provide the information that will be in the rules as soon as we can (this is the 2nd set of rules).

We will have a timeline in the next Anchor call for next steps. You are welcome to send questions related to implementation to the waiver mailbox.

We mentioned a Category 3 partial payment issue related to reporting on the call. The payment calculations for the first reporting period for DY 5 are in progress. We wanted to make you aware that Category 3 partial payment calculations that impact a small number of providers will be adjusted based on some conflicting information in the RHP Planning Protocol and subsequent implementation strategy. The providers that this impacts will be notified and this only affects providers in a positive, not negative manner, with their payments. Going forward, the partial achievement calculation for AM-2.x milestones will measure partial achievement over the approved baseline. This will increase the percent of goal achieved in DY5 for some providers reporting partial achievement of their AM-2.x goal. We’ll be updating the April DY5 reporting companion and the Category 3 Summary Workbook & Goal Calculator in the coming weeks to reflect this change.

Thank you for your continued work that benefits the health care of Texans.


Texas Health and Human Services Commission
Deputy Medicaid CHIP Director, Healthcare Transformation Waiver


From: HHSC Texas Healthcare Transformation and Quality Improvement Program

Anchors –

Based on our call with CMS today, we will plan to have the anchor call Thursday at 1:30 as scheduled.  In advance of the call, we are attaching the proposed Program Funding and Mechanics Protocol (PFM) for DY6, which CMS has indicated they are amendable to.  Most of the elements in this PFM are the same as the proposal previously posted on the waiver website and shared with you, and also includes some changes to Cat 3 and removal of the performance bonus pool previously discussed with anchors.  We will plan to discuss this proposal on the call tomorrow, including any changes from the version you have already seen.

In lieu of sending out Anchor Notes this week, please find additional important information below:

Category 3

Updated MPL for IT-12.2 Cervical Cancer Screening

  • HHSC has identified that the Minimum Performance Level for IT-12.2 Cervical Cancer Screening was incorrectly seeded into the Category 3 reporting companion. The MPL has been changed from .6837 to .6137. For most providers, this results in a lowered goals in DY4 and DY5. We’ve updated our internal database with the corrected MPL and adjusted DY4 and DY5 goals for impacted providers.

Category 3 DY5 R2 Interim Corrections

  • HHSC will have another Category 3 Interim Correction period this summer. Currently, we anticipate an interim correction period template being released the end of June, with a target due date back to HHSC of July 20th.
  • As a reminder the interim correction period is intended for making corrections to:

– P4P outcomes that have previously reported performance

– Outcomes that have a custom goal

– P4P outcomes that have not been reviewed by MSLC.

  • The DY5 R2 interim correction period will allow corrections to previously reported and approved baseline, PY1, PY2, and PY3 due to errors in measure interpretation or data collection. The October DY5 Category 3 reporting template will still allow corrections to prior reporting for P4R outcomes and P4P outcomes that have not yet reported performance and do not have a custom goal. The interim correction period is not intended for outcomes that need to make corrections to DY5 R1 reporting due to a “Needs More Information” determination.

Updated Category 3 Summary Workbook

  • HHSC will be releasing an updated Category 3 Summary Workbook & Goal Calculator prior to the interim correction period. This update will include DY5 R1 reporting.

New Baselines and Baseline Corrections submitted in the April DY5 Reporting Template

  • HHSC will be reviewing baselines newly reported or corrected through the April DY5 reporting template in June and contacting providers individually if any follow up TA is needed. HHSC hopes to have this review complete by mid-July.

Statewide Learning Collaborative

  • Just a reminder that registration for providers and anchors for the SLC is open.  We have gotten some inquiries from providers, and we are directing them to contact their anchor to coordinate registration.
  • We have received a few templates nominating projects to highlight at the SLC.  We’d like as many as possible to consider, so please let us know if you need additional time.  We are hoping to finalize the agenda soon so we can get it out to participants sooner than in prior years.
  • As in years past, we would like to showcase DSRIP success stories that represent the breadth and depth of projects across the state. This year, we would particularly like to highlight the specific impact on the uninsured population and on those in the Medicaid program. This could also include projects that impact both Medicaid and uninsured with explanations of the benefits for both. Given where we are with the waiver extension and ongoing negotiations over a new five-year waiver, we believe that focusing on outcomes specifically for these two populations will be most beneficial.
    • We would like your help in gathering information from hospitals and other providers in your RHPs. Specifically, we would like:


  1. Video submissions focusing on DSRIP outcomes. These video stories should be no more than 2 minutes. We prefer not to have patient narrative stories. Videos should discuss a particular DSRIP project and its impact on the uninsured and/or Medicaid enrollees.
  2. For hospitals and other providers that do not have the capability of submitting a video, the other option is to submit two PowerPoint slides. The first slide should give a brief project description and the second slide should detail outcomes for the uninsured and/or those in the Medicaid program.


  • Thank you in advance for your assistance in reaching out to your RHP providers and in making the learning collaborative a success!




Healthcare Transformation Waiver Operations
Texas Health and Human Services Commission

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May 02

15-month 1115 Waiver Extension Approved

Hello Region 2,

I am pleased to share with you the email sent to the Anchors this morning from HHSC.  CMS has officially approved a 15-month extension of the 1115 Waiver for Texas, which is a key stepping stone to a longer continuation of the program.  This confirms the expectation of DY6 (“transition year”) and the beginning of DY7, which is expected to be the starting point for Waiver 2.0.  As noted below, negotiations are ongoing regarding that longer extension.  Please see the attached approval letter and the Special Terms and Conditions (STCs).

The successes of DSRIP to date and the input that everyone has provided on where this is going has been extremely important in getting to this point.  The Region 2 Anchor Office wishes to thank each and every one of you for your hard work, and we look forward to even further success as the 1115 Waiver moves forward.


Craig S. Kovacevich, MA
Associate Vice President,
Waiver Operations &
Community Health Plans
UTMB Health
409.766.4047 (Office)

1115 Medicaid Waiver – RHP 2
UTMB HealthCare Systems
UTMB Community Health Plans


Dear Anchors –

HHSC has received confirmation from CMS that a 15-month waiver extension has been approved. A longer term extension will continue to be negotiated. Please see below the press release going out this morning.  We will share the relevant documents and additional information with you very soon, but wanted to get this initial information out to you now.

The Health and Human Services Commission and the Centers for Medicare and Medicaid Services have agreed to extend a state and federal partnership that finds innovative ways to deliver healthcare.

The 1115 Waiver, which funds Uncompensated Care and the Delivery System Reform Incentive Payment Program (DSRIP), was extended 15 months under an agreement between the health agency and CMS. The agreement will take the program through December 2017 and will maintain its current funding.  Over the next 15 months, HHSC and CMS, which oversees the Medicaid program, will continue negotiating a longer term extension.

DSRIP consists of local programs working to improve health care delivery costs and outcomes. There are 1,451 DSRIP projects across 20 regions in the state. In each region a coalition of governments, hospitals and other providers are charged with coming up with novel solutions to containing health care costs while preserving access and quality. Most projects focus on increasing primary and preventative care, which not only improves outcomes, but saves money by reducing the need for expensive emergency room visits. The waiver program also helps hospitals with uncompensated care costs.

The Uncompensated Care program and Delivery System Reform Incentive Payment programs are funded through a combination of federal and local money. Both Uncompensated Care and DSRIP contribute $3.1 billion a year, each.


Healthcare Transformation Waiver Operations
Texas Health and Human Services Commission

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Mar 21

Category 3 Summary Workbook Update

Good afternoon Region 2,

HHSC has released the attached document that reflects the Category 3 values as they currently have them recorded. As referenced in the email below, each provider is being asked to review each of their Category 3s and report any discrepancies to the HHSC Waiver mailbox ( by COB next Wednesday, March 30th.

Susan Seidensticker, BSIE, MSHAI, CPHQ, CSSBB, PMP
Director, Waiver Quality Operations
University of Texas Medical Branch (UTMB)


Anchors and Providers,

Category 3 Summary Workbook:

Attached please find an updated Category 3 Outcome Summary Workbook. The attached workbook will be posted to the waiver website next week. This update includes changes from DY4 R1 NMI responses, approved Interim Corrections, completed MSLC reviews, baseline PFPM submissions, and technical assistance conducted since January. The updated Category 3 Outcome Summary Workbook also contains DY5 R1 reporting and correction eligibility for all outcomes.

Providers should review project selection and reporting history for accuracy as this is the information that will be used to populate the April DY5 reporting template. Please send an email to the waiver mailbox if inaccuracies are identified in the following fields:

  • IT Selection & Subsets
  • Milestone Structure
  • DY4/DY5 Goals
  • Measurement Periods
  • Reporting Eligibility
  • Percent of Goal Achieved

Please send any needed corrections to the waiver mailbox by Wednesday, March 30th.

April DY5 Reporting Template Corrections:

In October DY4, the Category 3 reporting template was only able to accommodate corrections to outcomes that were reporting achievement of DY4 milestones. In April DY5, the Category 3 Reporting Template will be able to accommodate corrections for both outcomes reporting for achievement and those providing a status update. P4P outcomes that have not yet reported performance will be able to make corrections to the reported baseline numerator and denominator through the reporting template. P4R outcomes will be able to make corrections to all prior reporting history. After the April DY5 reporting period, HHSC will have another Category 3 Interim Correction period for outcomes that have already reported performance, and are not eligible to submit corrections through the April DY5 Category 3 Reporting Template.

Thanks for all your hard work and have a great weekend.

Medicaid/CHIP Transformation Waiver Operations
Texas Health & Human Services Commission


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Mar 04

RHP 2: Metric Report

Good morning Region 2,

HHSC has provided the attached metric report for your review.  This is updated through the October DY4 NMI period; if the contents do not match what you have in your records, please contact the HHSC mailbox ( immediately and copy Susan Seidensticker ( on that correspondence.

Thank you,


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Jan 27

Waiver extension documents posted to HHSC’s waiver website

Dear Region 2,

HHSC has posted additional information to their website regarding the proposals for the DY6 Transition Year.

As of today, the following are available (new documents highlighted in blue):

  • Transition Year (DY6) Proposal – Program Mechanics and Funding Protocol (1/26/16)
  • Proposed Regional Performance Bonus Pool Measures (1/26/16)
  • Updated Transformational Extension Protocol (Menu) with Best Practices/Models (1/26/16)
    o   Please note that this version contains only those project options that are allowed to be created as new (replacement) projects under the HHSC proposal to CMS
  • Summary of the Transformational Extension Protocol (Menu) for Replacement Projects – HHSC Proposal (9/4/15)
  • DSRIP Extension Planning and Protocols Webinar (9/30/15)

Additionally, HHSC has two survey links on their website regarding the Transition Year and Extension.

Thank you,


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Jan 20

DY4 UC IGT Commitment Notification

Good Afternoon RHP2,

Please see the email below from the HHSC Rate Analysis team regarding “2015 DY 4 UC IGT Commitment Amounts” and required commitment forms due by COB January 25, 2016.

To ensure that all government entities receive this notification, HHSC strongly encourages you to send this information to any government entity who is IGT’ing on your behalf.

If you have any questions please don’t hesitate to contact us.

Thank you,




The purpose of this e-mail is to provide demonstration year 4 (DY 4) uncompensated care (UC) and intergovernmental transfer (IGT) data to all UC providers and Anchors for the UC payment to be processed in February 2016.  The attached file contains the maximum UC payment for this round of the DY 4 payment, the maximum IGT commitment for each provider and a request for the final IGT commitment from providers.  This is not the final DY 4 UC payment.  There will be a final DY 4 UC payment pending the resolution of Texas Children’s Hospital and Seattle Children’s Hospital vs. Burwell et al., Civil Action No. 14-2060, in the US District Court for the District of Columbia. HHSC is holding back 5 percent of the total DY 3 UC allocation to address possible changes to all hospitals’ HSLs pending the resolution of Texas Children’s Hospital and Seattle Children’s Hospital vs. Burwell et al., Civil Action No. 14-2060, in the US District Court for the District of Columbia.  Upon final resolution of this case, HHSC will make a final DY 4 UC payment based on the court decision.

At this point, eligible providers and/or their government entities are asked to view the “2015 DY 4 UC IGT Commitment Amounts for Publication” tab of the attached workbook, locate their hospital and its associated “Maximum IGT for February 2016 DY 4 UC Payment (Prior to Haircut)” amount in Column K and complete the IGT commitment form by entering the IGT amount they are committing for the February 2016 DY 4 UC payment.  The commitment form must be returned to HHSC at by close of business on January 25, 2016.

Please determine the IGT amount you wish to commit up to the limit contained in Column K.  While you may commit to IGT the maximum amount in Column K, providers have the option to commit less than the maximum in order to ensure that they do not exceed their HSLs at the time of the UC interim and final reconciliations or if they do not have enough IGT available to fund the maximum amount.  Provider’s IGT commitments should take into consideration their own determinations of whether they might be paid above their HSLs at the time of the interim and final UC reconciliations.  Being paid above their HSLs would subject providers to recoupment at the time of the reconciliations.

It is the responsibility for each provider to coordinate with their Government entities to determine the amount(s) that each Government entity is committing to. This is necessary to ensure that providers do not exceed their maximum IGT commitment. It is the responsibility of the provider receiving the payment to submit this form to HHSC by the designated due date.

HHSC will impose a “haircut” to determine the actual DY4 UC payments upon receipt of their proposed IGT commitments. The size and distribution of the haircut will be dependent on amount the IGT commitments and the DY4 funds available.

To ensure that all government entities receive this notification, HHSC strongly encourages anchors and providers to send this information to any government entity who is IGT’ing on their behalf. 

Below are the pertinent dates associated with the DY4 UC payment:

  • January 25           DY4 UC IGT Commitment Due
  • January 27           DY4 UC IGT Notification sent to industry
  • February 4          Last date to transfer funds into TexNet
  • February 5           DY4 UC IGT Settlement Date
  • February 16        DY4 Transferring Entities (Big 6) Payment Date
  • February 29        Latest DY4 UC Payment Date

To avoid having to revise your TexNet entries, do not enter your IGT amount into TexNet until you receive the final version of the calculation workbook from HHSC.  The final version, with the haircut, is expected to be released on January 27, 2016.

If you have questions regarding the UC payment process, please send an email to

Thank you,

HHSC Hospital Rate Analysis

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Jan 20

1/15/16 Anchor Update

Good afternoon Region 2,

We wanted to make sure that everyone was aware of the latest information received from HHSC regarding combining projects in the Transition Year (DY6) and the ability to correct Category 3 information for those measures that have already reported DY4 performance.  Additionally, please also note below the extension from CMS for Medicaid provider re-enrollment; the previously announced deadline of March 24th has now been replaced with September 25th.

The attached zip file contains 4 items:

    • Cat-3-Interim-Corrections-Template-DY5R1-20160115.xlsx, which can pull, by each Category 3 metric, the previously reported information.
      o   It does appear that HHSC has enabled the ability to modify the date range of the baseline.
      o   Please note that if you are correcting more than one Category 3 metric, you will need to save each one as a unique file. File naming convention per HHSC should be RHP02_ProjectID_Cat3Correction
      o   All corrections that are proposed must be sent to the HHSC mailbox by COB on Friday, February 12th
    • Cat-3-Summary-Goal-Calculator-20160115.xlsx.  This is for informational purposes only, as it is intended to allow providers to confirm current reporting information and determine new goals if corrections are anticipated.
    • Combining Projects Companion Document.pdf.  This is the how-to guide for combining projects either within a provider, across providers and/or across regions.
    • DSRIP-Project-Combination-Template.xlsm, which is the template for proposing project combinations.
      o   Please note that if you elect to do this, you will be asked to confirm the expected MLIU (or provide a new number with an explanation – the template appears to default to the highest MLIU of the projects being combined)
      o   Please note that the template defaults to indicate that all current Category 3 metrics continue.
      o   One project combination template per TPI.  If you’re not combining projects, no action is needed.
      o   All requests to combine projects must be sent to the HHSC mailbox by COB on Monday, February 1st using the subject line Combination Template, and a recommended file naming convention of RHP02_TPI_Project_Combination_Template.

As additional guidance becomes available, the Anchor Office will share it via email and our website (

Please feel free to reach out to our Waiver Analysts (Andrew Herndon, Anh Tu Pham, Karen Wong) or our Waiver Quality Director (Susan Seidensticker) if you have questions regarding this process.

Thank you,


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Jan 08

DSRIP 1/8/16 Anchor Notes

Good afternoon Region 2,

A special thank you to all of those who were able to join us in Galveston today.  Our Region continually demonstrates its strength and commitment to improving the health of those in our 16 counties.  As a reminder, the slides from today are available on our website (    Also, we look forward to seeing many of you at our Behavioral Learning Collaborative event in Lufkin next Friday; please contact Susan Seidensticker ( by COB Monday, January 11th, if you still need to RSVP.

Attached you will find three documents that were received today from HHSC.

      1. Anchor notes (PDF) dated January 8th. Please note the following:
        • October DY4 Reporting Timeline for payments to be processed.
        • Category 3 baseline correction timelines have been updated.  Please note that the “Interim Category 3 Correction template” will NOT be for those measures that held reporting of DY4 performance in the October cycle; these corrections are to be done as part of the April DY5 reporting template. If you have additional questions after reviewing the HHSC information on page 3 of the Anchor notes, please contact Susan Seidensticker (
        • Waiver Renewal updates:
            o   Please note that the information will come out in increments, with the first components expected to be available by the end of next week (Combining Projects and the draft DY6 proposal document).
            o   HHSC has asked us to remind you that their stakeholder feedback survey is still available; please see the link on page 3 of the Anchor notes.
        • Medicaid Provider Re-Enrollment.  This information was sent to you from our office yesterday as a reminder that each DSRIP provider must be an enrolled Medicaid provider, and that providers must re-enroll by March 2016 to remain active in Texas Medicaid.  Please see the information on page 4 of the Anchor notes.


      1. DY4 Reporting Data (Excel):
        • This is the statewide summary, by Region, for the metrics and payments approved.
        • Please note that there appears to be a typo in column I for RHP2 – that should read “DY4 Payment Amount Approved”.


      1. DY5 Monitoring IGT (Excel):
        • This is the amount of IGT owed by each performing provider TPI number for DY5.  The Regional total for monitoring for this current demonstration year is $5M.
        • Please note that on page 2 of the Anchor notes. HHSC has noted that they expect to refund some of the monitoring IGT funds from DY3.

Thank you,


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