Information & Resources

Good Morning Region 10 Providers,

I have a few very important updates for you below.

Reporting

• October DY4 NMI Review Results were distributed on Friday, February 26 to providers who received NMIs during the October DY4 Initial Review. Due to technical difficulties with software upgrades, we had to resend some emails on Thursday, March 3^rd.
• HHSC sent an Active Users Report to each Anchor to collect any changes to user status or contact information to ensure that providers and their IGT entities have access to the reporting system for April DY5. This update is due back to the RHP Mailbox (RHP_Region_10@jpshealth.org) by Monday, March 21st. After this deadline, changes must be submitted using an RHP Contact Change Form to the waiver mailbox.
• Preparations for April DY5 reporting are underway, including updating the Companion and developing a new Category 3 reporting template.  If HHSC has any reporting webinars it will likely be to go through the new Cat 3 template, but HHSC will let us know soon.

Category 3 Update:

• Partial Payment: HHSC has received a number of questions in the waiver box asking about carryforward for outcomes that reported partial achievement in DY4. HHSC has attached an example from previous reporting webinars that clarifies partial payment calculations. As a reminder, reporting partial achievement of a Category 3 DY4 milestone does not change your Category 3 measurement periods. Unlike QPI, Category 3 measurement periods are not extended if a goal is not fully achieved during the measurement year. The Performance Year 1 measurement period is the twelve months immediately following baseline. Performance Year 1 is associated with DY4 achievement milestones. The Performance Year 2 measurement period is the 12 months immediately following Performance Year 1.  Performance Year 2 is associated with DY5 achievement milestones and DY4 milestones carried forward due to partial achievement.
• Stretch Activities: Providers will report Stretch Activity milestones in October DY5. For Stretch Activity 3 (Program Evaluation), HHSC will be providing a template to summarize your final report for reporting purposes. The template will be similar to a cover page. This template will be available prior to the October reporting period.
• Interim Corrections: HHSC has started review of Interim Corrections submitted in February and will notify providers of approval or any needed follow up by March 11^th.
• PFPM Baseline Submissions: HHSC has started review of Population Focused Priority Measure baselines submitted in February and will notify providers of approval or any needed follow up by March 11^th.
• Category 3 Summary Workbook Update: HHSC will be updating the Category 3 Summary Workbook currently posted to the waiver website. The current target date is March 14^th. This update will include any changes made through the NMI reporting period, baseline TA for baselines reported in October DY4, approved interim corrections, approved PFPM baselines, and baselines under review by MSLC that have been reported to HHSC. This update will also include April DY5 reporting eligibility. HHSC will send anchors a regional Category 3 summary of selection and reporting details included in the Category 3 Summary Workbook.

Statewide Events Calendar

Please let me know if you have any questions.

Good Morning Region 10 Providers,

I have a few brief updates for you this morning. As always a summary of the Anchor Call Notes is below and I ask that you please read the attached Anchor Call Notes in their entirety.

October DY 4 Reporting

• On January 29, 2016, October reporting DY3 DSRIP payments will be processed for all providers and DY4 DSRIP payments processed for remaining providers that were not paid on January 15, 2016. Note that there are separate transactions for each payment for each DY.

Category 3

• HHSC has also posted an Interim Category 3 Correction Template to the waiver website for outcomes that will make corrections during the interim correction period, if corrections are needed. The Correction Template will indicate if an outcome is eligible to make corrections during the interim correction period, or if the outcome can be corrected at the time performance is reported. The final due date for submitting interim corrections is Sunday, February 14th. Providers do not need to submit a correction template if no corrections are needed, even if the template shows them as eligible to submit an interim correction.
• HHSC will be posting a revised Population Focused Priority measure (PFPM) baseline reporting template early this week. All providers with an alternate achievement outcome (AM-3.1 in DY5) will be asked to submit a baseline for their selected measure. This is to prepare for reporting in April DY5, if eligible. The deadline for returning the PFPM baseline template is tentatively scheduled for Sunday, February 14th.

Waiver Renewal Planning

• In addition, HHSC plans to share the following waiver renewal planning information with stakeholders in January that are specific to the transition year (DY 6):
  • Combining Projects: Template and companion document for combining projects have been posted on the HHSC waiver website on the Tools and Guidelines page under Combining DSRIP Projects.
  • Draft Transition Year (DY6) Proposal: HHSC plans to post the draft language for the Program Funding and Mechanics Protocol (PFM) relating to the transition year (DY6) during the week of January 25, 2016.
    • HHSC also plans to post a survey for stakeholder feedback on this information during the week of January 25, 2016 -- we will be looking at information received by Feb. 2nd as a first look prior to the Executive Waiver Committee, but will continue to keep the survey open after that date for additional feedback.
• Draft list of Performance Bonus Pool and Statewide Analysis Plan measures that builds on the information presented at the Statewide Learning Collaborative is scheduled to be sent out for feedback by the week of January 25th.
• A list of best practice models HHSC has identified for project options on the Transformation Extension Menu for replacement projects is also scheduled to be sent out for feedback by the week of January 25th.

Please let me know if you have any questions.

Good Morning Region 10 Providers,

I have a lot of information to share with you this morning. Please see the information below from HHSC.

HHSC has not yet received feedback from CMS on the draft Transition Year plan. CMS understands the urgency of HHSC and DSRIP entities being able to plan for the next year, and HHSC hopes to receive feedback by the end of this month or early February.  In the meantime, HHSC is proceeding as planned with the Transition Year documents and processes as outlined. They are still finalizing the draft Transition Year PFM language so that is now planned for this week. Information on the draft performance bonus pool measures, and the best practices models for the Transformation Extension Menu for replacement projects is still planned for this week, along with survey links for stakeholder feedback. 

Combining Projects

• Attached is the companion document and template for combining projects.  The companion document outlines the criteria, requirements and timeline for requesting to combine projects. 
• Please note the deadline for template submissions to HHSC is February 1, 2016 at 5:00pm.

Category 3

• Providers were sent their summary review file for outcomes that reported baselines during October DY4 reporting, and notified of any flags for technical assistance last Friday.  HHSC will be sending Anchors a regional baseline review summary early this week.
• Attached is a Cat 3 Reporting Summary and Goal Calculator.  This file will enable providers to confirm current reporting information and determine new goals if corrections are anticipated. It will also be posted on the waiver website.
• Also attached is the Interim Category 3 Correction Template, which will also be posted on the website. The 1/8/15 Anchor Call Notes described which outcomes are able to submit needed corrections during the interim baseline correction period. The Correction Template will indicate if an outcome is eligible to make corrections during the interim correction period, or if the outcome can be corrected at the time performance is reported. The final due date for submitting interim corrections is scheduled for Friday, February 12^th.

Deadline Extension for Provider Re-enrollment

• The Centers for Medicare and Medicaid Services (CMS) recently announced that the previous March 24, 2016 deadline for Medicaid provider re-enrollment is extended to Sept. 25, 2016. Though this extension gives states additional time to ensure providers comply with Patient Protection and Affordable Care Act (PPACA) requirements, Texas Medicaid encourages all providers who have not yet submitted a re-enrollment application to begin this process immediately to avoid potential payment disruptions. Additional information will be announced by HHSC Medicaid/CHIP in the coming weeks to assist providers who are working on the re-enrollment process. 

The attached files will also be posted as soon as possible on the waiver website. As always, let us know if you have any questions

Good Afternoon Region 10 Providers,

I hope that everyone had a safe and happy new year. I have a lot of information to share with you this morning, especially about Waiver Renewal. I have provided a summary below but I ask that you read the (attached) Anchor Call Notes in their entirety.

General Communication

• Attached you find the reporting and payment data used to populate the table in the Anchor Report.

October DY 4 Reporting

• The additional reporting period for metrics that need more information (NMI) is now open and will close at 11:59 p.m. on Friday, January 15, 2016.
• Any questions regarding submission of NMI documentation should be sent to the waiver mailbox at TXHealthcareTransformation@hhsc.state.tx.us by noon on Tuesday, January 12th in order for staff to respond to all of the questions by the Friday deadline. Please remember to include RHP, Project ID, and Metric ID with your questions.
• On January 15, 2016, October reporting DY4 DSRIP payments will be processed for transferring hospitals and top 14 IGT Entities.
• On January 29, 2016, October reporting DY3 DSRIP payments will be processed for all providers and DY4 DSRIP payments processed for remaining providers that were not paid on January 15, 2016. Note that there are separate transactions for each payment for each DY.
• A note on findings for DY4 QPI reporting and moving toward Waiver extension: There were a number of providers who are falling more than 20% below the Medicaid/Low-Income Uninsured (MLIU) QPI target. For those projects where MLIU is not required, this does not impact achievement of the metric. However, as HHSC looks towards waiver renewal, HHSC is planning to strengthen the MLIU component of QPI milestones, as this is the target population for the Waiver. HHSC strongly  encourages providers, especially those falling short of their MLIU targets, to work toward increasing the number of MLIU patients served.

Monitoring IGT

• Attached you will find the DY5 Monitoring IGT amounts. HHSC plans to request $5M for DY5 Monitoring IGT.
• HHSC is reviewing actual MSLC costs compared to the $4M collected for DY3 Monitoring IGT. HHSC estimates that IGT refunds for unused DY3 Monitoring IGT will be processed in early 2016. HHSC does not expect to process DY4 Monitoring IGT refunds.

Category 3

• HHSC is currently finalizing reviews of Category 3 baselines submitted during the October DY4 reporting period that were not flagged as Needing More Information. This week HHSC will send providers a summary of reported baselines and goals, as well as any notes regarding needed technical assistance.
• HHSC will be posting an Interim Category 3 Correction Template to the waiver website within the next two weeks.
  • Pay for Performance outcomes that are not under review by MSLC that have already reported DY4 performance, or are approved for an alternate achievement level or maintenance or P4R due to small volume will submit any needed corrections during the interim baseline correction period.
  • All other outcomes will be able to make corrections to the reported numerator/denominator when performance is next reported. T
  • he Correction Template will indicate if an outcome is eligible to make corrections during the interim correction period, or if the outcome can be corrected at the time performance is reported.
  •  The final due date for submitting interim corrections is tentatively scheduled for Friday, February 12th.
  • For outcomes not eligible to submit corrections during the interim correction period, HHSC will also be posting a Cat 3 project specific reporting summary and goal calculator so that providers can confirm current reporting information and determine new goals if corrections are anticipated.
  • The DY5 goals currently included in the online reporting system are out of date and will be removed prior to the April DY5 reporting period.
  • In mid-January, HHSC will distribute a revised Population Focused Priority measure (PFPM) baseline reporting template and provide guidance on submitting a DY3 or DY4 baseline for the selected alternate achievement outcome. All providers with an alternate achievement outcome will be asked to submit a baseline for their selected measure, regardless if a baseline was previously submitted.

Waiver Extension Application

• Based on the discussions thus far with CMS, HHSC believes an initial 1-2 year extension is probable to enable more time for more detailed negotiations for the later years in the extension.
• HHSC has not received formal written feedback from CMS, but anticipate getting some initial feedback from CMS on the transition year proposal and the initial extension request later this month.
• For DSRIP, CMS asked Texas to explore further financial integration of DSRIP into Medicaid managed care (i.e., running some DSRIP payments through the managed care plans, similar to NAIP). We explained at a high level the operational complexities of this (300 varying providers) and also that one of the DSRIP target populations is low income uninsured. CMS understands these considerations, and asked HHSC to explore potential options to move in this direction. HHSC is analyzing internally and will share more with stakeholders as we have more information.

Waiver Renewal Planning

• HHSC is continuing to review projects to determine if a project is eligible to continue or requires changes for the waiver extension period. HHSC reviewed additional projects based on October reporting submissions and will notify the projects that need to submit additional information.
  • HHSC will begin notifying individual providers of the results and required changes for the extension period the week of January 19th.
  • In addition, HHSC plans to share the following waiver renewal planning information with stakeholders in January that are specific to the transition year (DY 6):
  • Combining Projects: Template and companion document for combining projects will be posted this week.
  • Draft Transition Year (DY6) Proposal: draft language for the Program Funding and Mechanics Protocol (PFM) relating to the transition year (DY6) will be posted this week.
    • The waiver renewal survey will be updated for stakeholder feedback on this information this week – HHSC will be looking at information received prior to Feb. 5th for the Executive Waiver Committee, but will continue to keep the survey open after that date for additional feedback.
    • Draft list of Performance Bonus Pool and Statewide Analysis Plan measures that builds on the information presented at the Statewide Learning Collaborative is scheduled to be sent out for feedback by the week of January 25th.
    • A list of best practice models HHSC has identified for project options on the Transformation Extension Menu for replacement projects is also scheduled to be sent out for feedback by the week of January 25th.

Medicaid Provider Re-Enrollment

• To participate in DSRIP, each DSRIP provider must be an enrolled Medicaid provider. Based on federal requirements, tens of thousands of Texas providers must re-enroll by March 2016to remain active providers for Texas Medicaid.
• HHSC encourages all DSRIP providers who enrolled in Texas Medicaid prior to January 1, 2013, and have not yet re-enrolled, to do so as soon as possible.
• Please see the Anchor Call Notes for further information on how to re-enroll.

Please let me know if you have any questions.

Good Morning Region 10 Providers,

I have a lot of very important information to share with you this morning. Below is a brief summary of the Anchor Call notes but I ask that you please take the time to read them through in their entirety.

October DY 4 Reporting

• HHSC has completed its October DY4 reporting review. Reporting results were sent out to providers on Friday, December 11, 2015. If providers did not receive a summary file of their October DY4 Reporting Results, please have them contact the waiver mailbox at TXHealthcareTransformation@hhsc.state.tx.us. Please note HHSC will not re-review metrics that received a “Needs More Information” determination between the Initial and Needs More Information (NMI) review periods. Providers should upload their additional documentation to DSRIP Online Reporting System during the additional reporting period.
• As indicated in the Initial Review Results email sent to providers, HHSC may have made corrections to the initially selected achieved by status and percent of goal achieved selection in the online reporting system for Category 3 milestones. In places where the online reporting system and the October DY4 Category 3 Template did not match, HHSC corrected the online reporting system to match the reporting status indicated in the Category 3 template. HHSC has attached a summary of October DY4 Category 3 Reporting Template achievement status. This summary includes milestone level reporting and achievement status for each Category 3 outcome as indicated in the submitted Category 3 Reporting Template.
• The additional reporting period for NMIs is now open and will close at 11:59 p.m. on Friday, January 15, 2016. Any questions regarding submission of NMI documentation should be sent to the waiver mailbox at TXHealthcareTransformation@hhsc.state.tx.us. Please remember to include RHP, Project ID, and Metric ID with your questions.
• HHSC Rate Analysis will send out the notice for IGT requests for January 2016 DSRIP payments this week. Please follow the instructions within the email to ensure timely DSRIP payments and contact Rate_Analysis_DSRIP_Payments@hhsc.state.tx.us if you have questions regarding IGT processing. If you have questions regarding payment calculations or reporting review results, then please contact the waiver mailbox TXHealthcareTransformation@hhsc.state.tx.us.
• IGT for October reporting DSRIP payments will be due on January 4, 2016.
• On January 15, 2016, October reporting DY4 DSRIP payments processed for transferring hospitals and top 14 IGT Entities.
• On January 29, 2016, October reporting DY3 DSRIP payments processed for all providers and DY4 DSRIP payments processed for remaining providers that were not paid on January 15, 2016. Note that there are separate transactions for each payment for each DY.

Compliance Monitoring

• Cat 1&2 Validation – MSLC has notified providers of the metrics that were selected for review and has starting reaching out to providers to request additional data and sample documentation.

Monitoring IGT

• A reminder that the DY5 Monitoring IGT will be calculated based on IGT commitments as of January 1, 2016. HHSC may request up to $5M for DY5 Monitoring IGT. If IGT Entities have changes in funding DSRIP projects, please submit an IGT Entity Change Form prior to January 1, 2016. The form is located on the waiver website at: http://www.hhsc.state.tx.us/1115-docs/DY3-Templates/April2014/IGT-Entity-Change-Form.xlsx.
• HHSC is reviewing actual MSLC costs compared to the $4M collected for DY3 Monitoring IGT. HHSC estimates that IGT refunds for unused DY3 Monitoring IGT will be processed in early 2016. HHSC does not expect to process DY4 Monitoring IGT refunds.

Category 3

• HHSC has previously stated that interim baseline corrections will resume in January. Given the volume of baseline corrections and the success of updating baselines through the DY4 performance reporting template, HHSC will only be accepting interim corrections for a small selection of baselines. Specifically, outcomes that have already reported DY4 performance in either April or October of DY4 will be able to submit corrected baseline and performance rates in January. Outcomes with a current HHSC approved alternate achievement request, in maintenance mode, or utilizing Scenario 1 will be able to submit corrected baselines in January. All other outcomes will correct their baselines at the time of DY4 performance reporting. HHSC will be releasing a Category 3 goal calculator so that providers can confirm their goals prior to reporting, and determine if technical assistance is needed prior to performance reporting or if baselines can be corrected during the interim correction period.
• In early 2016, HHSC will distribute a revised Population Focused Priority measure (PFPM) baseline reporting template and provide guidance on submitting a DY3 or DY4 baseline for the selected alternate achievement outcome. All providers with an alternate achievement outcome will be asked to submit a baseline for their selected measure, regardless if a baseline was previously submitted. This is to prepare for possible reporting in DY5. All providers who were approved by HHSC to select an alternate outcome measure (PFPM or P4P Cat 3 outcome measure) as a result of being transitioned to maintenance mode for high performance should inform HHSC of their selected alternate outcome measure as soon as possible.
• HHSC has attached an updated list of Stretch Activity and Population Focused Priority measure selections. This list is current as of September 30th, 2015. HHSC recently released additional guidance for providers reporting Stretch Activity 3. As the volume for other stretch activities is fairly small, HHSC will not be producing additional guidance for other Stretch Activities. At this time, providers may only change a current selection to Stretch Activity 3, and may not switch to any other stretch activity if not currently selected.
• A number of providers have expressed concern to MSLC about the compendium specifications for the following outcomes: IT-1.10 HbA1c poor control, IT-1.11 BP control, IT-1.21 Adult Body Mass Index (BMI) Assessment, IT-1.7 Controlling high blood pressure, and IT-12.4 Pneumonia vaccination status for older adults. Specifically, providers are concerned about the denominator requirement for a clinic visit in the 12 months prior to the measurement period. Based on input from MSLC and providers, HHSC has determined that providers may waive the requirement for an encounter in 12 months prior to the baseline measurement period for these outcomes. Providers should report with consistent specifications across baseline and performance reporting periods. Going forward, providers who waive this encounter requirement will not need written approval from HHSC. Providers should note this deviation from specification when reporting or correcting prior reporting for these outcomes. Myers and Stauffer will be reaching out to providers with impacted outcomes to confirm their decision to waive the requirement. HHSC has included in today's notes a summary of MSLC's assessment of the clinical impact of waiving the prior year encounter requirement for providers to review before making a decision about waiving the encounter requirement.

Waiver Renewal Planning

• The link to the survey for stakeholder feedback on protocol level proposals for the 1115 Transformation Waiver Extension Application remains open: #. More information can be found on the waiver website’s Waiver Renewal page.
• Attached is information on the transition year (DY 6) proposal that has been communicated to CMS, which is consistent with the September webinar.
• The waiver team is focusing on additional details for the proposed transition year (DY 6) and targets December 2015/early January 2016 to provide additional information and will update the survey for feedback at that time
• HHSC is continuing to review projects to determine if a project is eligible to continue or requires changes for the waiver extension period and plans to provide information in January as previously communicated. Almost all of the projects reviewed will be eligible to continue, but some will require strengthening or next steps. HHSC may add additional projects for review based on October reporting submissions.
• "Rebalancing": HHSC is proposing that DY7-10 valuation across Categories 1-3 and the performance bonus pool (formerly Category 4) be redistributed to fixed percentages of a provider’s total DY valuation. During DY2-5, distribution of funding across Categories varied based on the Program Funding and Mechanics Protocol requirements, initial provider determinations, withdrawn projects, and valuation changes. Currently, Category 1 and 2 DY5 valuation ranges from 25 to 82 percent of total provider DY5 valuation. Similarly, Category 3 DY5 valuation varies from 18 to 69 percent of total provider DY5 valuation. With the changes to DSRIP in the waiver extension (streamlining Category 1 and 2 milestones, changing Category 3 to pay-for-reporting and Category 4 to pay-for-performance for the Performance Bonus Pool), HHSC proposes to standardize funding across Categories while maintaining total provider valuation. HHSC will work with stakeholders to determine the distribution across Categories and submit for CMS review.

• For example, Provider A has the following projects and funding distribution in DY5:

Update on Waiver Extension Application

• HHSC met with CMS in November regarding the extension application. HHSC hopes to receive formal written feedback from CMS either in December or January.
• HHSC anticipates getting some initial feedback from CMS on the transition year proposal this month.
• For UC, CMS indicated that Texas' ask is more than what CMS thinks is warranted. HHSC will do the required independent analysis, but asked for an extension beyond the CMS requested submission date of May 31, 2016.
• For DSRIP, CMS asked Texas to explore further financial integration of DSRIP into Medicaid managed care (i.e., running DSRIP payments through the managed care plans, similar to NAIP). HHSC explained at a high level the operational complexities of this (300 varying providers) and also that one of the DSRIP target populations is low income uninsured. CMS understands these considerations, and asked HHSC to explore potential options to move in this direction. HHSC is analyzing internally and will share more with stakeholders as they have more information.
• Based on the discussions thus far with CMS, HHSC believes an initial 1-2 year extension is probable to enable more time for more detailed negotiations for the later years in the extension.

Please let me know if you have any questions.

Good Morning Region 10 Providers,

I have a few brief updates for you this morning.

Waiver Extension

• In late November, HHSC received from the federal Centers for Medicare and Medicaid Services (CMS) the attached letter, which they had been expecting. To support Texas’ extension request for the Uncompensated Care (UC) pool in the 1115 Transformation Waiver, the letter requests that HHSC submit an independent analysis by May 31, 2016 of the impact of the UC pool on overall UC in the state, Medicaid provider rates, Medicaid beneficiary access to services, and a number of other areas.
• HHSC plans to ask for more time to submit the analysis, but given the tight deadline they plan to pursue an interagency agreement with a public state university to help complete the analysis.
• HHSC continues to be optimistic about a waiver extension. They anticipate getting CMS’ initial written feedback and questions on the extension application submitted in September in the coming weeks. They will keep you apprised as they have more information.

October DY4 Reporting

• Providers can expect to receive results of the October reporting period next week (estimated for December 9^th).

Please let me know if you have any questions.

Good Morning Region 10 Providers,

I have few updates for you this morning.

Category 3 Stretch Activity 3

• Attached is a guidance document for Category 3 Stretch Activity 3. This will give you a framework for working on a program evaluation for reporting in October DY5 if you have a Category 3 outcome that requires the completion of Stretch Activity 3. HHSC will also post this on the waiver website under Category 3.
• HHSC is developing a template for reporting your SA3 evaluation findings to HHSC, so look for that early next year.
• Questions related to other stretch activities should be sent to the waiver mailbox.

Waiver Extension Feedback

• HHSC will continue to keep it open in its current form until they have any updates to make based on conversations with CMS, at  which point they will update it for additional stakeholder feedback on new items or changes. 

Myers & Stauffer Webinar

• Attached are the presentation and a Q&A document from the webinar MSLC held on November 4^th about their process for Cat 3 baseline reviews and Cat 1 and 2 validation.   HHSC will also post these documents on the waiver website under Recorded Webinars/Conference Calls (although there is no recording of this webinar).

Potential Grant Opportunity

• The Substance Abuse Mental Health Services Administration (SAMHSA) recently released a Funding Opportunity Announcement for grants to expand care coordination Targeted Capacity Expansion (TCE) through the use of Technology Assisted Care (TAC) in targeted areas of need.  This could be a good opportunity for DSRIP Anchors and/or providers to coordinate and provide recommendations to the state.

Good Morning Region 10 Providers,

I have a few updates for you this morning.

Waiver Extension Application

• CMS notified HHSC on October 14^th that Texas’ extension submission is complete.  They have posted the submission on the Medicaid.gov website for a 30 day public comment period that started October 15th.

Waiver Evaluation

• Beginning November 1, 2015, the Waiver Evaluation Team will begin the second and final round of data collection for the Interorganizational Network Study. Members of the evaluation team will contact representatives of organizations that participate in DSRIP to schedule a 30-45 minute telephone survey.

Category 3

• Category 3 Reporting Template Bug: There is a known bug in the Category 3 Reporting Template impacting Category 3 outcomes with 2 parts (7 and 30 day follow up, for example), where the second Rate 2 of 2 is not showing as complete in the summary tab. Providers encountering this bug may submit their template as is, providing all other outcomes are showing as complete and all required data fields have been filled.
• Category 3 Certification Clarification for outcomes that are not reporting in October DY4: When certifying the Category 3 Oct DY4 reporting template, HHSC is asking for certification that information reported/corrected in October DY4 is accurate. When printing and signing the certification page, certifiers can strike through any previously reported baselines on the printed certification page that are not accurate and will be corrected at a later date.
• For Category 3 outcomes with baselines currently under review by MSLC: If a provider with a current corrective action plan from MSLC reports DY4 achievement in October DY4, the corrected baseline and DY4 performance will be reviewed by MSLC and further audits of DY4 performance may occur. For Pay for Performance (PFP) outcomes, if an MSLC review determines that the actual AM-1.x milestone percent of goal achieved is less than the percent of goal achieved reported by the provider in DY4, recoupment of unearned portions of the DY4 achievement  milestones will occur. If portions of achievement milestones are recouped in DY4, providers could be eligible to earn unearned portions of DY4 achievement in DY5 through the Category 3 partial payment and carryforward process. The eligibility to earn carried forward portions of DY4 achievement will be contingent on completion of MSLCs corrective action plan and is subject to approval by MSLC, HHSC, and CMS pending a review of the outcomes reporting and compliance monitoring history. DY5 performance reporting may also be subject to compliance monitoring.
• Please remember that Friday, October 23^rd is the last day to submit a question about October reporting to the HHSC mailbox(TXHealthcareTransformation@hhsc.state.tx.us).

Please let me know if you have any questions.

Good Morning Region 10 Providers,

I have a few brief October Reporting updates for you this morning.

October DY 4 Reporting

• Category 3 Certification Clarification for outcomes that are not reporting in October DY4: When certifying the Category 3 Oct DY4 reporting template, HHSC is asking for certification that information reported/corrected in October DY4 is accurate. When printing and signing the certification page, certifiers can strike through any previously reported baselines on the printed certification page that are not accurate and will be corrected at a later date.

• For Category 3 outcomes with baselines currently under review by MSLC: If a provider with a current corrective action plan from MSLC reports DY4 achievement in October DY4, the corrected baseline and DY4 performance will be reviewed by MSLC and further audits of DY4 performance may occur.

• For Pay for Performance (PFP) outcomes, if an MSLC review determines that the actual AM-1.x milestone percent of goal achieved is less than the percent of goal achieved reported by the provider in DY4, recoupment of unearned portions of the DY4 achievement  milestones will occur. If portions of achievement milestones are recouped in DY4, providers could be eligible to earn unearned portions of DY4 achievement in DY5 through the Category 3 partial payment and carryforward process. The eligibility to earn carried forward portions of DY4 achievement will be contingent on completion of MSLCs corrective action plan and is subject to approval by MSLC, HHSC, and CMS pending a review of the outcomes reporting and compliance monitoring history. DY5 performance reporting may also be subject to compliance monitoring.

• If you would like the Anchor Office to review any of you October reporting information please let us know by sending an email to (RHP_Region_10@jpshealth.org).

Please let me know if you have any questions.

Good Morning Region 10 Providers,

Happy October Reporting! I know that each of you are working diligently on October Reporting and I wanted to share with you all of the updated reporting documents posted on the HHSC website.

Included in the attached zip folder are:

• Category 3 DY 3 Status Template
• Category 3 FAQs
• Category 3 DY 4 Baseline & Performance Template
• DY 4 Category 4 Template
• Learning Collaborative Reporting Template (updated)
• October DY 4 QPI Companion Document
• October DY 4 QPI Template
• October DY 4 Online Reporting User Guide
• October  DY 4 Reporting Companion Document
• DY 4 Reporting Coversheet

In the Reporting Webinar Presentations folder there are individualized presentations  from the reporting webinar yesterday.

Please let me know if you have any questions.

Good Morning Region 10 Providers,

I have a lot of information to share with you this morning. Please take the time to read through the attached Anchor call notes. In the attached zip folder you will find the following reporting documents:

• Category 3 DY 3 Status Template
• DY 4 Category 4 Template
• Learning Collaborative Reporting Template
• October DY 4 QPI Companion Document
• October DY 4 QPI Template
• October DY 4 Online Reporting User Guide
• October  DY 4 Reporting Companion Document
• DY 4 Reporting Coversheet

Statewide Learning Collaborative

• As a reminder, we have requested feedback from participants of the 2015 Statewide Learning Collaborative (SLC) Summit.  HHSC has extended the response deadline from October 2nd, until Monday, October 4th at 5pm CST. The survey can be accessed at the following link and should take only a few minutes to complete: #.
• Also regarding the SLC, HHSC is uploading the SLC recordings to a YouTube channel:  SLC 2015. All 10 of the videos should be uploaded Today. HHSC will post these links to the waiver website when all of the videos have uploaded.  

October DY 4 Reporting

• All providers should complete their Semi-Annual Reporting (SAR) requirements and submit documentation for metrics they have been achieved by September 30, 2015. The deadline for October DY4 reporting submissions is 11:59pm on Saturday, October 31, 2015.
• Reporting materials, including instructions, guidance, and templates, can be found on the Tools and Guidelines for Regional Healthcare Partnership Participants page on the waiver website under October DY4 Reporting. Items noted as “Pending” should be posted early this week.
• HHSC will be holding an October DY4 Reporting Webinar on Thursday, October 8, 2015 from 10:00–11:30am which will cover General Reporting, Quantifiable Patient Impact (QPI), and Category 3 guidance. The webinar log-in information can be found on the waiver website’s Dates and Deadlines page. The webinar will be recorded and it will be posted on the waiver website about a week or so afterwards.
• Reporting questions or issues with the reporting system should be sent to the waiver mailbox at TXHealthcareTransformation@hhsc.state.tx.us. Please include the RHP number, Project ID, and metric ID when submitting questions. If an error is being submitting with the reporting system, please mention the page the error occurred on and identify the button that was clicked when the error occurred. Please note the final date to submit questions regarding October reporting and inform HHSC of any issues with DY4 data in the reporting system is Friday, October 23, 2015.
• For October DY4 reporting IGT changes, HHSC plans to post the estimated IGT due based on reported achievement by November 6, 2015. Providers may submit IGT changes (i.e., changes in IGT Entity or proportion of IGT funding) by November 20, 2015, instead of by the end of the reporting period on October 31, 2015.

Category 3

• HHSC has reviewed all changes sent by providers in response to Category 3 summaries sent out last week. HHSC has sent anchors an updated regional file reflecting these changes, as well as individual zip files for distribution to providers. These files will be emailed to the lead providers for each organization early this week. As HHSC prepares for seeding the October DY4 reporting template, please only contact HHSC if the revised summary files identify a critical error (either incorrect IT selection or milestone structure).
• The Category 3 October DY4 reporting template and Category 3 Reporting FAQ are currently scheduled for release to providers on Tuesday, October 6th.

QPI

• As a reminder, all providers with a DY4 QPI metric are required to fill out a DY4 QPI template for SAR purposes - this is required for all providers - even those who have already reported DY4 QPI metrics for completion and those who are not ready to report yet for DY4. Providers should update data to demonstrate encounters provided/individuals served through September 30, 2015.
• Just as a heads up, there is a slight formatting change to data entry cells in Step 6 (noted in the Companion and on the instructions tab). The functionality remains the same, but the formatting change saved a lot of room in the file size.
• October DY4 is the last occasion to report a DY3 Carryforward.  If a provider is unable to achieve the DY3 Carryforward, they may forfeit their DY3 QPI payment and achievement and be able to start counting DY4 QPI from the beginning of DY4.  Instructions for doing this will be in the QPI Companion and covered during the Reporting Webinar on October 8th.

Compliance Monitoring/Mid-Point Assessment

• Category 1 and 2 metrics review. MSLC is restarting its review of Category 1 and 2 reported information for DY2 and DY3. To minimize impact on the providers, during October MSLC will be reviewing available information for the selected metrics, which includes reported information submitted by the providers and QPI templates.
• In November, MSLC will start sending out communication to the providers whose metrics are selected for the review. MSLC will provide instructions to providers on what information to submit and how to submit it.
• As previously communicated, DY 2-3 metrics included for the review are selected process milestones and QPI metrics.
• Estimated completion date of the review is April of 2016.

Waiver Renewal Planning

• The slides for the DSRIP Extension Planning and Protocols webinar are posted on the Waiver Renewal page, and the recording should be posted in about a week or so. 
• As stated in the webinar, CMS has given HHSC the go-ahead to push back the formal submission date for the DSRIP protocols until late spring/early summer 2016, so HHSC will have more time to work with stakeholders to flesh out what will be submitted.
• HHSC is working on a communications process for feedback from stakeholders from the initial proposals in the webinar, and information we receive from CMS. This will include feedback already received (such as through the public meetings), so stakeholders do not need to duplicate input. HHSC will notify you once the process is posted on the waiver website.

Alignment with Managed Care

• The Texas External Quality Review Organization and HHSC Managed Care Operations Quality team are hosting a 2015 Fall Texas Medicaid/CHIP Managed Care Quality Forum & Collaborative PIP Workshop on November 5 and 6. The PIP Collaborative Workshop will be November 6. HHSC plans to invite providers who will be partnering with MCOs on their 2016 required PIPs to the workshop.
• Please be on the lookout for the email with registration information. It should be sent out after October 9.

Good Morning Region 10 Providers,

HHSC will be holding an October DY4 Reporting Webinar on Thursday, October 8, 2015 from 10:00–11:30am which will cover General Reporting, Quantifiable Patient Impact (QPI), and Category 3 guidance. The webinar log-in information can be found on the waiver website’s Dates and Deadlines page at http://www.hhsc.state.tx.us/1115-Waiver-Deadlines.shtml. If you are unable to attend the webinar at this time, it will be available on the waiver website about a week or so later.

General Reporting Reminders:

• The October DY4 reporting period is the final opportunity to report achievement on DY3 Carryforward metrics.
• Milestones and Metrics must have been completed by September 30, 2015 in order to report achievement and earn payment.
• The reporting system will close on October 31, 2015 at 11:59pm.
• Semi-Annual Reporting (SAR) Requirements:   Providers are required to report twice a year, whether or not they are reporting achievement for their milestones and metrics. If a provider does not submit information for the following required fields, DSRIP payments may be withheld until the complete report is submitted which also includes future payments.
  • Provider Summary (Located on the Provider Homepage in the DSRIP Online Reporting System)
  • Project Summary (For all Cat 1 and Cat 2 projects - located on the Project Reporting page)
  • Progress Update fields (For all Cat 1 or Cat 2 metrics and Cat 3 milestones - located on the milestone tabs)
  • QPI Template for ALL DY4 QPI Metrics (A completed template with QPI data through September 30, 2015 must be uploaded for ALL DY4 metrics that are marked as “Y” for QPI.)
  • QPI:   Please remember to use the Pre-DSRIP Baseline when inputting data into the QPI template. The provider should NOT be using baselines established during DSRIP which may be listed in their QPI metric’s baseline/goal language.
  • Documentation:   Supporting documentation should only be uploaded to metrics that are reporting achievement for payment and DY4 QPI metrics (regardless if they are reporting achievement or not). HHSC will not be reviewing documentation uploaded to metrics that are NOT reporting achievement.
  • Reporting System Access: If additional team members require access to the reporting system, please submit an RHP Contact Change Form to the waiver mailbox at TXHealthcareTransformation@hhsc.state.tx.us. (PLEASE NOTE: If a user has recently transferred organizations and noted so in the User Update that was submitted at the end of September, the user may use his/her old username unless otherwise notified. Please use your new email address if you need to reset your password.)

Good Morning Region 10 Providers,

I have a few updates for you this morning.

Webinars

• HHSC scheduled the October DY4 Reporting webinar for Thursday, October 8, 2015, 10:00 – 11:30 am Central Daylight Time.
• A reminder that the webinar on DSRIP Extension Planning and Protocols is scheduled for next Wednesday, September 30, 2015 from 1:30 – 3:00 pm.
• If you did not receive webinar access information for the Reporting webinar or the Planning and Protocol webinar please send an email to the RHP 10 mailbox at (RHP_Region_10@jpshealth.org) and I will send the information to you. 

Category 3

HHSC sent out provider-level Category 3 outcome summary files last Monday. The information below is to clarify the process for updating Category 3 baseline information.

• For all Category 3 outcomes requiring corrections, including those under review by Myers and Stauffer (MSLC):

• If the baseline measurement period and/or the subset need to be corrected, the provider should send an email to the Waiver mailbox outlining the requested changes ASAP.

• Providers should NOT send information to HHSC regarding outcomes that do not require changes to baseline measurement periods or subsets. In the interest of time prior to October reporting, HHSC will not be responding to emails requesting other types of Cat 3 changes next week.

• The process for updating baseline information other than baseline measurement periods or subsets is as follows:

• For providers reporting performance of a Category 3 outcome measure in October DY4 reporting: If a baseline needs to be corrected due to errors in abstraction or understanding of measure interpretation, updates can be made through the October DY4 reporting template at the time DY4 performance is reported. 

• For providers not reporting performance of a Category 3 outcome measure in October DY4 reporting:
  • If the outcome is under review by MSLC, no action is needed by the provider. When MSLC completes their entire review, they will send HHSC their findings, and HHSC will update records at that time.
  • For outcomes not under review by MSLC on which the provider is not reporting performance during October DY4 reporting (i.e., they are carrying forward), if a baseline needs to be corrected due to errors in abstraction or understanding of measure interpretation, providers will have an opportunity to make these changes during or prior to April DY5 reporting.

• As a reminder, while all Category 3 outcomes with a reported DY3 baseline (including those under review by MSLC) will be eligible to report DY4 performance in October. All reporting is subject to compliance monitoring. In cases where compliance monitoring determines that actual achievement is less than reported achievement, payments above actual achievement will be recouped. Providers uncertain of their baselines are strongly encouraged to carry forward reporting of their DY4 performance. This will reduce the possibility of recoupment and additional administrative work for the provider and HHSC.

Good Morning Region 10 Providers,

I just wanted to give you a brief update this morning.

DSRIP Extension Protocols

• CMS has given HHSC the go-ahead to push back the formal submission date for the DSRIP protocols until late spring/early summer 2016, so HHSC will  have more time to work with stakeholders to flesh out what will be submitted.  Since the time pressure has lessened a bit regarding the extension protocols HHSC will be able to focus efforts on what the transition year will look like.  HHSC will have more information on that in the upcoming 9/30 webinar.   

Category 3

• HHSC will be sending provider-level Category 3 outcome summary files early this week (target is today), copying the Anchors. The files will contain each current Category 3 IT selection including milestone structure, reporting history, baseline numerator and denominator if reported and DY4 and DY5 goals if applicable. The information in the files will be used to update milestones in the online reporting system and populate the October DY4 Category 3 reporting template.  Providers will have an opportunity to let HHSC know about needed corrections by September 25^th; more information will be in the email sent this week.
• HHSC is no longer accepting baseline correction forms for baselines reported in October DY3 or April DY4.  Updates to baseline numerator and/or denominator (due to errors in abstraction or understanding of measure interpretation) can be made through the October DY4 reporting template at the time DY4 performance is reported.

Please let me know if you have any questions.

Good Afternoon Region 10 Providers,

I have a few updates for you this afternoon.

• The DSRIP Extension Webinar has been scheduled for Wednesday, September 30, 2015 from 1:30 – 3:00 pm, Central Daylight Time.  HHSC will be discussing planning for transition and working with CMS on the protocols. The call-in information was sent out to providers and Anchors.  Each of you should have received a meeting invite from me containing all of the webinar access information.

• The SLC evaluation survey link was sent out to SLC participants and all providers – #. HHSC is hoping to get feedback from both in-person participants and those who viewed via live stream.  The survey will be open until COB Friday, October 2nd.

• Attached is the letter HHSC received in July from CMS concerning approval of DY4 & DY5 DSRIP valuations. A provider recently inquired about it, so they thought it might be of interest to others.   

• HHSC will be sending out requests for additional information for projects under HHSC review for continuation in the extension period starting next week through October 9th and may send additional requests starting again in November through December. Providers will have one week to respond and may request additional time if needed. HHSC will only be contacting providers if they need additional information so some providers may not hear from HHSC. Additional projects may be added to the review after October reporting. HHSC plans to notify all providers of the review results in late January.

• MCO plans were provided their Performance Improvement Project (PIP) assignments in August. They were encouraged to collaborate with a DSRIP project. “For those plans that are required to conduct a collaborative PIP in 2016, we encourage you to reach out to the Regional Health Partnerships (RHPs) in your area to find DSRIP projects that align with your 2016 PIP topic or intervention ideas. . . PIP plans will be due by COB October 9th.” Attached, please find a list of the assignment topics by MCO plan and contact information (though not yet complete) for the plans. The RHPs each MCO serves (listed by STAR/CHIP and STAR+PLUS) are listed in the columns on the right.

• The RHP 10 Anchor Office would like to invite you to join the In the Spirit of Recovery Team for the 2015 NAMI walk. Information on registering is available at ##&panel1-2.

Please let me know if you have any questions.

Good Afternoon Region 10 Providers,

I have a lot of information to share with you this afternoon. I have complied a brief summary of the Anchor Call notes below, but I ask that you please read through them in their entirety.

DY 4 October Reporting

• HHSC wants to encourage providers to check the Online Reporting System to review their Category 1 and 2 DY3 carryforward and DY4 metrics they have not yet reported for achievement, and begin sending any questions about metrics or documentation so HHSC will have time to respond.  Please note that recent Category 3 changes are not yet integrated into the Online Reporting System.
• The estimated payments for approved April NMI milestones and metrics are attached. Please refer to column G "DY4 Round 1 NMI Approved DSRIP" and column K "DY3 Round 1 NMI Approved DSRIP" for the NMI approved amounts that will be included for January 2016 payments.

Category 3

Baseline TA:

• HHSC continues to work with providers on outstanding issues related to Category 3 baselines reported in October DY3 and April DY4.
• HHSC will aggregate all changes made through the Category 3 baseline TA process and baseline corrections and send an updated summary of Category 3 baselines and reporting status to Anchors and providers for review with a current target date of September 18th.

Reporting Template:

• In the October DY4 reporting period, all Category 3 reporting will be done in one provider template including both baseline reporting and DY4 performance reporting.
• As providers are needing to make baseline corrections as a result of improvements in data integrity and understanding of measure specifications, the October DY4 reporting template will include the option to correct a currently reported baseline due to errors in outcome interpretation or data collection. If a baseline is corrected through the reporting template, the template will be able to recalculate DY4 and DY5 goals in most scenarios and determine percent of DY4 goal achieved. Providers will not be able to add or remove approved subsets or change measurement periods during the reporting process.

Milestone Structure for Non-standard Baselines:

• As a reminder, in cases where  a provider has no or inadequate data to establish a baseline that ends by 09/30/2014 (the end of DY3), DY4 data may be used to establish a baseline and this results in a change to the Category 3 milestone structure. Outcomes approved to report with a DY4 baseline must report a baseline with 12 months of data, and the 12-month period should be as early as possible and end no later than the end of DY4.
• Providers intending to report a baseline with DY4 data should notify HHSC prior to October reporting as this results in a change to the DY4 payment structure, removing the DY4 achievement milestone. Providers who report a baseline with DY4 data and do not contact HHSC prior to the October reporting period will not be eligible to receive the DY4 funds associated with their AM-1.x achievement milestone during the October reporting period.

Meyers & Stauffer:

• By September 30th, providers with Category 3 baselines selected in Round 1 or Round 2 of review will receive preliminary notifications and corrective action plans if needed.
• MSLC will begin working with providers to complete corrective action plans and finalize baseline corrections beginning in October, extending through December 2015.
• HHSC will not be removing reporting eligibility for October DY4 reporting based on Myers and Stauffer findings.

October DY 4 Reporting Eligibility:

• All outcomes with a reported DY3 baseline will be eligible to report DY4 performance in October. All reporting is subject to compliance monitoring and in cases where compliance monitoring determines that actual achievement is less than reported achievement, payments above actual achievement will be recouped.
• Providers uncertain of their baseline are strongly encouraged to carry forward reporting of their DY4 performance. This will reduce the possibility of recoupment and additional administrative work for the provider and HHSC.

Population Focused Priority Measures & Stretch Activities

• HHSC will be posting a revised Population Focused Priority (PFP) Measures menu to the HHSC website and it is also attached to this email. The menu has been updated to reflect the final selection PFP IDs and the corresponding Category 3 Measure for specifications.
• HHSC has not yet reviewed PFP baselines that may have been reported in October DY3 or April DY4, and will begin that process in January 2016.
• HHSC is working on enhanced guidelines for Stretch Activities and these will be available after the October reporting period, with providers eligible to report achievement of Stretch Activities in October DY5. Stretch Activity milestones (PM-11) do not need to be reported in the same reporting period as their associated Category 3 outcome reporting (PM-10 or PM-12).

3-Year Project Change Requests

• HHSC has completed the review of the submitted change requests, and MSLC has completed their review of those change requests that required their secondary review.
• The RHP 10 Anchor Office requests that any responses back to HHSC be submitted to the RHP mailbox (RHP_Region_10@jpshealth.org) by September 18^th.

Compliance Monitoring/Mid-Point Assessment

• Addendum to the Mid-Point Assessment Report with results of the review of 3 year projects is completed and attached. There are three attachments for this addendum: 3 Year Project Review Methodology, Appendix 1- 3 Year Projects Risk Ranking, and  Appendix 2-3 Year Projects Analysis Recommendations Responses.

Statewide Learning Collaborative Summit

• HHSC will be sending out a Survey Monkey link requesting feedback on both the content and structure of the event.  This survey will be open and emailed to participants, planned by Tuesday, September 8th and will remain open until Friday October 2nd.

Waiver Renewal Planning

• HHSC has submitted the waiver extension packet to the Governor's office for submission to CMS by September 30, 2015.
• The DSRIP protocol webinar is tentatively planned for Wednesday, September 30, 2015 from 1:30 p.m. - 3:00 p.m.
• HHSC will be posting the proposed extension menu for replacement projects and a survey for feedback soon. The extension menu is also attached.
• HHSC also plans a survey for feedback on the Statewide Analysis plan after the webinar, to include Categories 3 and 4 and the performance bonus pool.
• For overall planning HHSC will stagger the feedback loop to account for providers reporting in October, and HHSC's review of reporting in November, for the planned timeline of protocol submissions to CMS in early 2016.

General Updates

• HHSC wants to reiterate for all waiver stakeholders an issue that may impact available UC funds in DY5. In November-December 2011 when waiver negotiations with CMS were being finalized, HHSC paid out $466 million in UPL funds and CMS added a provision to the waiver requiring that during the 5-year waiver term, these payments be offset against the UC pool (i.e., reducing UC pool payments by $466 million). HHSC has not yet done this offset, which could reduce the amount of UC funds available in DY5 from $3.1 billion to less than $2.8 billion. HHSC plans to count toward the UPL offset recoupments as each DY's UC payments (based on a 2-year data lag) are reconciled to actual UC costs that year. For example, for DY1 this recoupment amount is almost $100 million. HHSC should also be able to do the DY2 reconciliation before DY5 payments are finalized (DY2 recoupment amount still TBD). To the extent that HHSC can offset recoupments against the $466 million, this will reduce the payment reduction from the DY5 UC pool. HHSC will keep stakeholders updated as we have more information.
• Attached you will find the RHP 10 DY 4 revenue summary. If you have any questions, updates or comments please let me know.

Please let me know if you have any questions.

Good Afternoon Region 10 Providers,

I know that many of you attended the Statewide Learning Collaborative but I wanted to be sure to share with you all the presentations that were given. The presentations can be found at http://www.hhsc.state.tx.us/1115-Waiver-Deadlines.shtml. I will be sure to send out information once the video recording is available. Also, attached is the presentation specifically given on Waiver Extension and Protocols. I implore each of you to read through this information and if you have any questions please let me know.

Good Afternoon Region 10 Providers,

HHSC has provided the below additional guidance on QPI.

In reporting to date, HHSC has found that Quantifiable Patient Impact (QPI) reporting remains challenging. We wanted to provide some reminders on QPI in advance of October reporting, including what it is intended to measure and how the template works, with special focus on the pre-DSRIP baseline.

QPI is intended to capture the impact of a DSRIP project by measuring the increase in the number of individuals served or encounters provided as a result of that project. Another way to think about the QPI is to think about the change in the provider's workload as a result of DSRIP funding.

To that end, the QPI template is set up to isolate the number of individuals served or encounters provided (based on the metric’s QPI grouping) in any one demonstration year (DY) as a result of the DSRIP intervention. To do this, it compares the level of service in that DY against the level of service prior to the start of the project. That level of service prior to the start of the project is your pre-DSRIP baseline. In practice, the template will subtract the pre-DSRIP baseline from the total level of service (individuals served or encounters provided) in the DY for which you are reporting.

Pre-DSRIP Baseline:

Every QPI metric will have only one pre-DSRIP baseline. The pre-DSRIP baseline is the point of comparison for each DY and will not change over the life of the waiver. The pre-DSRIP baseline is established the first time the provider reports a QPI metric, and is a number that indicates the number of individuals served or encounters provided in the year before the start of any DSRIP interventions. If you have reported the QPI metric for achievement, your pre-DSRIP baseline for that QPI metric cannot be changed. If you have only reported on a QPI metric for the purposes of the Semi-Annual Reporting (SAR) or program updates (you have not reported your QPI metric for achievement), the field (Step 5 in the QPI Template) to establish the pre-DSRIP baseline may still be changed in your QPI template. In that case, if you find you have made a mistake in the pre-DSRIP baseline, you may change it.

As a reminder, if your DSRIP project is providing a new service, your pre-DSRIP baseline is "0".

If your DSRIP project is an expansion of existing services, your pre-DSRIP baseline should be the level of service (encounters or individuals, depending on your QPI grouping) you provided in the year prior to the start of your DSRIP intervention, a number greater than 0. This is not to be confused with the level of service you provided in the early years of the DSRIP project (DY2 or DY3). Those may be a level of service upon which you plan to build, but are not the same thing as the pre-DSRIP baseline.

For example, let's say your project is to increase the number of individuals to whom you provide navigation services. Your practice previously provided navigation services, so this is not a new service. In the year before you implemented the expanded services, you provided navigation services to 378 individuals. In the first year of the expanded level of services with DSRIP funding, let's say DY3, you provide 621 individuals with navigation services. In your QPI template, in Step 5, Pre-DSRIP Baseline, you would report 378 individuals with the dates of 10/01/2011 to 9/30/2012. Remember to describe the data used to calculate the pre-DSRIP baseline. In Step 6, you would copy and paste the patient ID and date of service for all 621 individuals you served in DY3 (10/01/2013 to 9/30/2014). The template will then calculate your QPI for DY3, which will be 621 individuals minus 378 individuals of the pre-DSRIP baseline for a total DY3 QPI of 243 (621 - 378 = 243). Let's assume your goal was 230; you have met (and exceeded!) your QPI goal for DY3.

Building on that example, let's say your DY4 QPI goal is to provide services to 300 individuals. Your pre-DSRIP baseline will still be 378 individuals. You must then provide services to 678 individuals in total in DY4 to meet your DY4 QPI goal of 300 individuals (678 - 378 = 300).

Common Points of Confusion:

Baseline reference in your Baseline/Goal Statement:

• Sometimes, the baseline/goal statement talks about      improving over the previous demonstration year or an estimated baseline. Unless      the reference in this statement is the pre-DSRIP baseline that has been      reported for achievement and reviewed by HHSC, you may ignore the      reference in the baseline/goal statement. There is only one pre-DSRIP      baseline and it is from the period before the start of the DSRIP project.      It is established in the QPI template the first time you report for      achievement.

Numeric goal versus percentage goal:

• In most cases, your numeric goal is the numeric      equivalent of the percentage goal. For example,  your QPI metric goal      could be,  “Provide navigation services to 230 individuals, or 90% of      eligible patients.”  In this example, 230 individuals and 90% of      eligible patients are equivalent.  The 230 individuals would be      reported through the QPI template, but you would provide separate      documentation to show that 230 equals at least 90% of eligible      patients.  For these types of QPI goals, the numeric goal (230) is      the primary goal, while the percentage (90%) may vary with      explanation.  In other words, if 230 equals only 85% of eligible      patients, you would show that calculation through separate documentation      and include an explanation for why the percentage was lower than      expected.  The metric could still be approved for payment if the      numeric goal of 230 were achieved. 

QPI goals based on previous year estimates:

• In some instances, the QPI goal may be based on a      previous year of the DSRIP project, and the previous year volume was only      an estimate when the QPI goal was set.  For example, let's say in DY2      for this same project you expected to provide 400 individuals with the      intervention and your DY3 goal was 10% increase over the previous year.      The DY3 numeric goal was set at 40. But then, once you started the      project, you actually provided 500 individuals with the intervention in      DY2.  Even though the DY2 baseline level of service against which you      were comparing was only an estimate when the DY3 metric was drafted, you      should stick with the numeric goal that is included in the online      reporting system and in your template -- which would still be 40. If you      serve 50 additional individuals, all the better, but your achievement      will be measured by the numeric goal HHSC has on record.

In some instances, your QPI metric goal statement includes more than one QPI goal. A performing provider must achieve all of the goals in the “Baseline/Goal” in order to be eligible for payment for the metric.

• For example, your QPI goal is “Hire 1 new navigator to      provide navigation services to 230 individuals in DY3.” In this instance,      you should utilize the QPI template to demonstrate achievement of the 230      individuals metric, and then submit other supporting documentation through      the online reporting system as evidence of your hiring the new navigator.
• Another example is that you may have to achieve both      your percentage goal and your numeric goal, if they were intentionally      meant to measure different things. For example, you are providing new      trainings to providers throughout your diabetes clinic. Your QPI      baseline/goal statement is,  “250 patients will be impacted by the      new interventions, and 75% will provide a positive rating on the patient      survey.”  In this instance, your QPI template should reflect all      patients receiving the intervention -- so all patients who are treated by      the providers who have received the new training. And, the percentage that      provide a positive rating on the patient survey should be reported through      additional supporting documentation. The QPI templates are not set up      to calculate percentages.

We hope this information has helped clarify some common points of confusion. As always, if you have questions, please email the waiver mailbox at TXHealthcareTransformation@hhsc.state.tx.us. If you have questions specific to QPI, we encourage you to submit these questions as soon as possible.

Good Morning Region 10 Providers,

HHSC has arranged for the Statewide Learning Collaborative Summit to be available for viewing on-line, in real time, in order to allow all interested individuals to watch the proceedings.  To access the Summit via webcast on August 27^th and/or 28^th, please click on the HHSC Webcast link: www.zodiacstudios.net/texas-health-and-human-services-commission.html. The webcast will only stream the sessions that are occurring in the Grand Ballroom.  Please see the attached agenda for Summit sessions. 

A test stream will be available on August 19^th -  21^st each day between the hours of 8:00AM and 10:00PM at the same link in order for viewers to troubleshoot any firewall issues prior to the Summit.  If issues are encountered during the test stream, HHSC recommends facilities wanting to watch the Summit open up the ability to offer streaming through their firewall and test again to make sure it is working.

When you access this site during the test period or the Summit hours, please press play to begin watching on-going sessions. If at any time a participant leaves the webcast and returns later, you will need to click on the same link and press play to re-join. During the webcast, participants may submit questions through an online chat function. Questions will be answered after the Summit concludes.

For technical difficulties accessing the webcast, please send an e-mail to: TXHealthcareTransformation@HHSC.state.tx.us. Please feel free to share the webcast information with other interested individuals.

Please let me know if you have any question.

Good Morning Region 10 Providers,

HHSC has released the final agenda (attached) for the Statewide Learning Collaborative. I will send out more information, as it becomes available, for those who would like to watch the live streaming of the event.

Good Morning Region 10 Providers,

I have quite a bit of important information to share with you this morning.

HHSC DSRIP Dashboard

• HHSC posted a DSRIP Tableau Dashboard searchable statewide DSRIP database (along with the user reference guide) on the Regional Healthcare Partnership (RHP) Plans page. The DSRIP Tableau Dashboard presents Category 1-3 data in summaries and graphs. It allows project filters based on RHP, Provider Name, Provider Type, Project Option, Primary Project Type, and Category 3 Outcome.

DY 4 April Reporting

• Project payment summaries have been posted on the waiver website through April DY4 reporting.
• Provider and project reporting summaries have been posted on the waiver website containing provider-level and project-level status information submitted during the October DY2 through April DY4 reporting periods.

Category 3

• HHSC Staff are still conducting Category 3 technical assistance for baselines that were reported in October DY3 and flagged as needing baseline clarification or assistance in determining DY4 and DY5 goals. HHSC is contacting providers via email with a description of any outstanding baseline clarification or technical assistance issues, and either setting up a call or proposing a resolution.  All providers have been assigned to an HHSC staff member at this point, and we believe a dozen are still to be contacted.
• On Thursday HHSC sent out a provider level summary for baselines that were submitted in April. Providers reporting PM-9 for achievement in April DY4 should have received a spreadsheet outlining DY4 and DY5 goals, and any baseline clarification or technical assistance issues that need to be resolved before providers can report DY4 performance.
• As a reminder, to submit a correction to an already reported Category 3 baseline that has not been selected for compliance monitoring by Myers and Stauffer, please send an email to the waiver mailbox (TXHealthcareTransformation@hhsc.state.tx.us) indicating the Category 3 project ID of any baselines that need correction, and a brief description of the baseline issue. HHSC will then send the provider a Category 3 Baseline Correction Form specific to their outcome that should be completed by the provider and returned to the waiver mailbox. Please submit baseline correction forms to HHSC by August 15^th.
• HHSC has received a number of inquiries about the transition to ICD-10 and Category 3 reporting. HHSC will not be updating the compendium with new ICD-10 codes and they do not plan to issue a code crosswalk specific to DSRIP Category 3. HHSC asks providers (and Myers and Stauffer when relevant) to treat this as an instance where providers are using their best clinical judgment and then maintaining documentation of those clinical judgments and consistency throughout reporting periods. In this case, HHSC would allow providers to use whatever guidance/crosswalks they are applying system-wide for the transition (for example, CMS GEMs 2016). Please notify HHSC if you identify a specific instance where the transition may make comparison between measurement periods invalid.

Compliance Monitoring

• HHSC anticipates the Mid-Point Assessment Report for 3 year projects will be completed and released this week.
• HHSC is working with MSLC to expand the sample for the review of baselines to make sure that at least one Category 3 measure for each provider is reviewed during compliance monitoring.  Last week, a second group of providers was informed about Cat 3 review selection.
• Category 1 and 2 metrics review. MSLC started the first phase of the Category 1 and 2 reviews. Close to 100 projects are included in this phase. Providers were already notified and are in the process of submitting information for the FTP set up. MSLC will start with reviewing available reported information for the selected metrics. In case additional information is required, MSLC will ask providers to submit it.
• Due to the expansion of the work on Category 3 baseline review, MSLC will delay majority of additional requests for Category 1 and 2 review until later time.
• Below is a high-level timeline for work conducted by MSLC. Although October is listed, HHSC has informed MSLC that there will need to be additional flexibility afforded to providers during October due to reporting submissions that month.
  • May 2015 through September 2015 - Category 3 baseline review - baseline correctness
  • October 2015 through December 2015 - Category 3 baseline review - corrective action plan, technical assistance and follow-up
  • October 2015 through February 2016 - Category 1 and 2 validation - Round 1
  • March 2016 through May 2016 - Category 4 review
  • March 2016 through June 2016 - Category 1 and 2 validation - Round 2
  • May 2016 through August 2016 - Category 2 performance review and Population Focused Priority Measure Baseline Review

Waiver Renewal Planning

• A summary of all comments from the public hearings (including the webinar) have been posted on the waiver website on the Waiver Renewal page.
• HHSC will continue to work with stakeholders on detailed programmatic changes to the protocols not addressed in the waiver extension draft.
  • More information on protocol-level proposals will be provided at the Statewide Learning Collaborative Summit August 27 - 28.
  • HHSC tentatively plans to hold a DSRIP protocol webinar in September (rather than August as previously indicated).
  • HHSC has notified providers of projects that will be reviewed for possible changes for waiver renewal, including the reason for review.  Providers should notify HHSC by August 28, 2015 if they do not plan to continue any of the projects under review after DY5 or do not plan to use the funds for a replacement. That is the only action needed at this time. Note that HHSC will provide information regarding replacing and combining any current projects at the Statewide Learning Collaborative.

Statewide Learning Collaborative Summit

• HHSC will provide an update to the anchors of any unused and reallocated slots soon.
• Providers who have already been notified by HHSC that their posters were accepted may go ahead and register their poster presenter at this time if they have not already done so (even if they have already registered for their 1-2 provider slots).
• A more detailed agenda will be sent this week as details are finalized. 
• For projects that were selected to present a poster at the event, yesterday, August 10^th was the deadline to submit a PDF of posters to the Waiver mailbox(TXHealthcareTransformation@hhsc.state.tx.us).  HHSC has received a few questions inquiring as to whether they will be printing out the posters for this session.  HHSC is not able to provide printing services so providers will need to make arrangements to print posters prior to the event. If you are a poster presenter, please remember to bring business cards or one-pagers with contact information to provide to summit attendees.

Please let me know if you have any questions.

Good Morning Region 10 Providers,

I have quite a bit of information to share with you this morning.

DY 4 April Reporting

• July 31, 2015 ‐ April reporting DY2 and DY3 DSRIP payments processed for all providers and DY4 DSRIP payments processed for remaining providers that were not paid on July 21, 2015.  Note that there are separate transactions for each payment for each DY.
• August 7, 2015 – HHSC and CMS will approve or deny the additional information submitted in response to HHSC comments on April reported milestone/metric achievement. Providers who previously received “Needs More Information” (NMI) requests will receive coversheets summarizing metric achievement determinations no later than August 7. Approved metrics will be included for payment in the next DSRIP payment period, estimated for January 2016.

Category 3

• Next week, HHSC will be begin reviewing Category 3 baselines submitted during the April DY4 reporting period, and will notify providers of any needed baseline clarifications or technical assistance.
• HHSC has received additional Category 3 guidance prepared by Myers and Stauffer (referenced in the Compliance Monitoring notes section below) and is attached. Myers and Stauffer have prepared a summary of common baseline issues identified during their review for Category 3 Outcomes IT-1.10 Diabetes Poor Control, IT-1.11 Diabetes Care: BP Control,  and IT-1.13  Diabetes Care: Foot Exam. Providers are encouraged to review their own baselines to identify any of these common mistakes and take the necessary actions to correct any identified errors that result in a change to reported baseline.
• As a reminder, to submit a correction to an already reported Category 3 baseline that has not been selected for compliance monitoring by Myers and Stauffer, please send an email to the waiver mailbox indicating the Category 3 project ID of any baselines that need correction, and a brief description of the baseline issue. HHSC will then send the provider a Category 3 Baseline Correction Form specific to their outcome that should be completed by the provider and returned to the waiver mailbox. Please submit baseline correction forms to HHSC by August 15^th.

Compliance Monitoring

• HHSC is working with MSLC to expand the sample for the review of baselines to make sure that at least one Category 3 measure for each provider is reviewed during compliance monitoring.  Most likely next week a second group of providers will be informed about Cat 3 review selection.
• MSLC provided HHSC with the summary of common issues identified for three outcomes, IT-1.10, IT - 1.11 and IT-13.
• Attached you will also find a description of Myers & Stauffer process for Category 3 baseline review.
• Category 1 and 2 metrics review. MSLC started the first phase of the Category 1 and 2 reviews. Close to 100 projects are included in this phase. Providers were already notified and are in the process of submitting information for the FTP set up. MSLC will start with reviewing available reported information for the selected metrics.
• Due to the expansion of the work on Category 3 baseline review, MSLC will delay majority of additional requests for Category 1 and 2 review until a later time.

Waiver Renewal Planning

• The survey link (#)  for stakeholders to give comments on the draft will remain open until August 5th, when the public comment period ends.
• Comments at the public meetings are recorded and HHSC will read and consider all of the submitted comments. It is not necessary for stakeholders to comment on the draft waiver extension using more than one feedback mechanism.
• HHSC will continue to work with stakeholders on detailed programmatic changes to the protocols not addressed in the waiver extension draft.
  • More information on protocol-level proposals will be provided at the Statewide Learning Collaborative Summit August 27 - 28.
  • HHSC will tentatively plan to hold a DSRIP protocol webinar in September (rather than August as previously indicated)
  • HHSC will notify providers next week of projects that will be reviewed for possible changes for waiver renewal, including the reason for review.

Clinical Champions

• HHSC staff is working with members of the Clinical Champions group, based on members' area of expertise, to inform the preliminary development of the RHP Planning Protocol which will be used for replacement projects in the Renewal period.  This work is just starting and will continue over the coming months and opportunities for feedback will be provided. 
• Preliminary information from this process will be shared with providers at the Statewide Learning Collaborative Summit and will be used to inform and support the peer to peer learning sessions.

Statewide Learning Collaborative Summit

• HHSC has sent out the invitation/registration information for the August 27-28, 2015 statewide summit.
• HHSC is very close to finalizing panelists and breakout mentors for the Summit.  Both panelists and mentors will receive a registration slot for their participation.
• Please see the attached draft agenda that should assist with registration. Please be sure to register no later than July 31 (next Friday) if at all possible, to inform planning and redistribution of slots.

Please let me know if you have any questions.

Good Afternoon Region 10 Providers,

I wanted to send out a quick reminder that the Texas HHSC 1115 Waiver Renewal Public Meeting at Old Red Museum of Dallas County Culture and History - 4th floor Restoration Room will be taking place Tuesday, July 21^st from 10AM to 12 (noon). If you are interested in providing a public comment when you arrive please be sure to fill out the request to appear during the Public Hearing  form.  I recommend that you bring two copies of your comments, one to attached with the form and one for your personal reference. Comments during the public meeting will be limited to 3 minutes per person. Also, attached are the directions and parking instruction for the Public Meeting.

We are looking forward to your support of the Waiver renewal process.

Please let us know if you have any questions.

Good Morning Region 10 Providers,

I have quite a bit of important information to share with you this morning.

DY 4 April Reporting Timeline

• July 21, 2015 – April reporting DY4 DSRIP payments processed for transferring hospitals and top 14 IGT Entities.
• July 31, 2015 ‐ April reporting DY2 and DY3 DSRIP payments processed for all providers and DY4 DSRIP payments processed for remaining providers that were not paid on July 21, 2015.  Note that there are separate transactions for each payment for each DY.
• August 7, 2015 – HHSC and CMS will approve or deny the additional information submitted in response to HHSC comments on April reported milestone/metric achievement. Approved reports will be included for payment in the next DSRIP payment period, estimated for January 2016.

Category 3

• HHSC Staff are still conducting Category 3 technical assistance for baselines that were reported in October DY3 and flagged as needing baseline clarification or assistance in determining DY4 and DY5 goals.
• HHSC will be begin reviewing baselines submitted in April DY4 in July, and will notify providers of any needed baseline clarifications or technical assistance.
• HHSC has received several requests to the waiver mailbox to correct a Category 3 baseline that was randomly selected for compliance monitoring by Myers and Stauffer.  Myers and Stauffer will have a process in place to make any needed baseline corrections through their review process and providers do not need to contact HHSC to make changes to Category 3 baselines selected for compliance monitoring.
• To submit a correction to a reported baseline that was not selected for compliance monitoring, please send an email to the waiver mailbox indicating the Category 3 project ID of any baselines that need correction, and a brief description of the baseline issue, and HHSC will send the provider a Category 3 Baseline Correction Form to be completed by the provider and returned to the waiver mailbox.

QPI

• HHSC has resolved all outstanding DY5 QPI changes and notified providers of results if a lower DY5 QPI goal was proposed or the current DY5 goal was requested to be maintained.

3-Year Project Change Request Process (Plan Modification Requests and Technical Change Requests)

• July 17, 2015 – Final date to submit questions regarding change requests to HHSC at TXHealthcareTransformation@hhsc.state.tx.us with SUBJECT: CHANGE REQUEST QUESTION – RHP# – PROJECT ID#.
• July 22, 2015 – Change Request Forms (CRFs) and revised project narratives are due to the RHP mailbox (RHP_Region_10@jpshealth.org).

Compliance Monitoring

• Please be sure to read through the Anchor call notes section on compliance monitoring.
• HHSC will be work with MSLC to expand the sample for the review of baselines to make sure that at least one Category 3 measure for each provider is reviewed during compliance monitoring.
• Category 1 and 2 metrics review. MSLC is getting ready to start the first phase of the Category 1 and 2 reviews. Close to 100 projects will be included in this phase. For the projects included in the first phase, MSLC will review selected process milestones, reported QPI metrics and MLIU information. HHSC should have a list of these projects this week.

Waiver Renewal Planning

• HHSC has posted the 1115 Waiver Extension draft on the HHSC website’s Waiver Renewal page. Public meeting dates and locations have also been posted, as well as a new survey link for stakeholders to give comments on the draft.  
• Comments at the public meetings will be recorded and HHSC will read and consider all of the submitted comments. It is not necessary for stakeholders to comment on the draft waiver extension using more than one feedback mechanism.
• 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:
  • Click on Attend Meeting
  • Enter Meeting Number: 737 370 214
  • Call 866-430-8535
  • HHSC will continue to work with stakeholders on detailed programmatic changes to the protocols not addressed in the waiver extension draft.
  • HHSC tentatively plans to hold a DSRIP protocol webinar in August and also will discuss protocol changes at the August 27-28 Statewide Learning Collaborative Summit tailored to the summit audience.

Update on Private Hospital Deferral Financing Issue

• CMS confirmed via email that Texas will have until September 2017 to come into compliance with whatever CMS and HHSC agree upon as acceptable to address CMS concerns after the series of calls this summer.

Medicaid Benefits Coordination

• The HHSC Office of Policy has instituted a new benefits review process. The Transformation Waiver team is in coordination with the Office of Policy to use lessons learned and data from DSRIP to inform benefits that are reviewed.
• Please see the link below. At the bottom you will see a section called “Submitting Medicaid Medical or Dental Benefit Requests”  If DSRIP providers and other stakeholders have specific requests for a new Medicaid medical or dental benefit or a change to an existing benefit, please refer them to this web page and direct them to that last section.  They will complete the form and mail it along with supporting documentation to the Medicaid Benefit Request mailbox (per the instructions). http://www.hhsc.state.tx.us/medicaid/MPR/index.shtml

Statewide Learning Collaborative Summit

• HHSC has sent out the invitation/registration information for the August 27-28, 2015 statewide summit. As a reminder, the deadline to register is Wednesday, August 5^th. HHSC asks that providers register as soon as possible so that "leftover" slots may be reallocated to those providers who have requested to send additional participants. Please remember that performing providers with 10 - 19 active projects may send two representatives, and those with 20 or more projects are invited to send three.

Please let me know if you have any questions.

Good Morning RHP 10 Stakeholders,

HHSC has updated their Waiver Renewal webpage to include the 1115 Waiver Extension Application Draft with supporting documents. HHSC will be taking comments on this draft document during July at the statewide public meetings. HHSC will post a survey link on the Waiver Renewal website for stakeholders to provide feedback and comments on the waiver extension draft.

As a friendly reminder, the DFW public meeting will be hosted Tuesday, July 21, 10AM-12PM, at the Old Red Museum of Dallas County Culture and History - 4th floor Restoration Room (100 South Houston St. Dallas, TX  75202).

Please let me know if you have any questions.

Good Afternoon Region 10 Providers,

I hope that you all had time to attend the 3-Year Project Change Request webinar hosted by HHSC. I wanted to make sure that you received all of the documents related to the change requests.

In the attached folder you will find:

• 3-Year Project Change Request Companion Document
• The Change Request Form
• Slides from the change request webinar

The deadline to submit change requests to the RHP Mailbox (RHP_Region_10@jpshealth.org) is Wednesday, July 22^nd. If you are not planning on submitting a change request please be sure to send an email to the RHP mailbox indicating this.

Please let me know if you have any questions.

Good Afternoon Region 10 Providers,

Registration Information - Texas 1115 Healthcare Transformation Waiver Statewide Learning Collaborative (SLC) Summit/ August 27-28, 2015

The purpose of this e-mail is to invite you to participate in the 1115 Healthcare Transformation Waiver Statewide Learning Collaborative (SLC) Summit scheduled in Austin on Thursday, August 27^th and Friday, August 28^th at the AT&T Executive Education and Conference Center.   The deadline to register is Wednesday, August 5th.   Seats are limited, and therefore registration is required.   Background information, as well as registration instructions, is included below.

What is the Purpose of the SLC Summit?   The primary goal of the Summit for 2015 is to share outcome data and best practices from projects, highlight effective systems of care and discuss next steps as we look to the future of the 1115 Healthcare Transformation Waiver.   Guest speakers and your peers who participate in the waiver from across the state will present on shared learning and best practices.   Technical assistance also will be included for DSRIP providers, RHP anchors and other stakeholders on topics such as data analytics and quality alignment with Medicaid managed care. We will forward a full conference agenda to your attention prior to the Summit. 

How Have Summit Participants Been Identified?  Due to limited space, in-person attendance is capped at 500 attendees.   Every DSRIP performing provider will have an opportunity for at least one representative to attend in person. Performing providers with 10 - 19 active projects may send two representatives, and those with 20 or more projects are invited to send three. The SLC Summit will be webcast and have interactive capabilities so that individuals who are not able to attend may also participate (see more below).  In order to gain the most benefit from the Summit, we encourage individuals who attend in person in Austin to be actively engaged in project implementation.  Providers that have included statewide learning collaborative metrics in their projects will be able to submit supporting documentation whether attending in person or via webcast to meet metrics. HHSC will provide additional details for the documentation and participation required to meet metrics prior to the event.

If you have any questions about attendance or the invitation process, please email the waiver mailbox at txhealthcaretransformation@hhsc.state.tx.us.  

What If I Can’t Attend the Summit?  HHSC will broadcast the conference online so that individuals not able to attend in-person can watch presentations, hear discussions, and submit questions through an online chat function.  Once the details of the webinar are available, login instructions will be posted: http://www.hhsc.state.tx.us/1115-waiver.shtml   

How Do I Register for the Summit? To be guaranteed a spot at the conference, designated individuals must register at https://2015slcsummit.eventbrite.com by Wednesday, August 5th. The registration passcode is HHSC2015.  Upon completing registration, registrants will receive an e-mail confirming their registration. 

What Arrangements Should I Make?

• A limited number of group room rates at the AT&T Executive Education and Conference Center of $174.00 per night are available until Saturday, August 1, 2015. A limited number of Government room rates are also available at $126.00 per      night. 
• For standard group room rate reservations, please visit https://resweb.passkey.com/go/HHSCTEX815 to complete       your reservation.
• For government room rate reservations, please visit https://resweb.passkey.com/go/HHSCGOV815 to complete your reservation.
• Hotel information and directions can be found at the following website: http://www.meetattexas.com.       

• Hotel parking is available in the underground, attached garage. Guests may self-park or use valet services at the University Avenue entrance.
• The dress code is business casual.  Please keep in mind that hotel temperatures often fluctuate so consider bringing a sweater or jacket.
• Breakfast and lunch will be provided for all registered attendees both days  of the conference, but dinner will be on your own.
• Please come prepared to discuss your projects, share your successes and challenges, and learn from other providers across the state. You may bring any materials you think would be helpful for this purpose.

We are excited about the Summit, and look forward to your participation.  If you have any questions, please send your questions to:  TXHealthcareTransformation@hhsc.state.tx.us   

For providers with projects in multiple regions, HHSC proposes to use the same RHP assignments as last year for the purposes of coordinating SLC registration:

Please let me know if you have any questions.

Good Morning Region 10 Providers,

HHSC has  distributed the Initial Review Results for April DY4 Reporting to the RHP 10 providers. Individuals using the reporting system may also received an automated email informing them that the “Needs More Information” reporting period is now open on the DSRIP Online Reporting System. This additional reporting period will be open from 12:00 a.m. on Wednesday, June 10, 2015 to 11:59 p.m. on Thursday, July 2, 2015.  

It is during this time that providers with metrics or Semi-Annual Reporting (SAR) requirements marked as "Need More Information" or "Incomplete" must respond to HHSC requests for more information to be eligible for payment in January 2016.  Providers should respond and submit any supporting documentation to HHSC for additional review through the online reporting system.  Not responding to an NMI request will result in the providers either forfeiting all monies for that metric or delaying payments if they did not complete their SAR requirements.

NMI Reporting Reminders:

• Providers should continue to use coversheets to help explain their documentation.
• Only information needed to make a determination of metric achievement should be uploaded during this time.
• Documentation should include "NMI" at the beginning of the file name to help distinguish the newly uploaded files from the documentation that was submitted during the April reporting period.
• NMI responses can either be uploaded in a separate document or included as an additional update to the metric's Progress Update. Providers should not overwrite the original Progress Update that was submitted during the April DY4 reporting period.
• In the Online Reporting System, please note that the statuses shown on the Provider Details page, "Reporting Status" tab, for Category 1 and 2 projects are linked to their associated Category 3 projects since they are reported on the same project reporting page. Although a status may say that Category 3 has an NMI, it may be because the related Category 1 or 2 project received an NMI and vice versa.  It is important to check the individual milestone and metric tabs on the Project Reporting page to view the actual HHSC Signoff.
• HHSC will not re-review metrics that received a “Needs More Information” determination between the Initial and Needs More Information (NMI) review periods.  All “Needs More Information” metrics will be reviewed once the June/July provider response period closes based on information submitted to the online reporting system.  If a provider has submitted documentation to the Waiver mailbox for re-review, the provider should instead upload this information to the online reporting system and expect a response after the Needs More Information HHSC review period closes in August.

Payment Timeline:

• Late June – HHSC Rate Analysis will send out the IGT due amounts using the FMAP of 58.05. (Please do not refer to the IGT due amounts that are currently listed in the online reporting system, as they are not accurate.)
• July 8, 2015 – IGT due for April reporting DSRIP payments.
• July 21, 2015 – April reporting DY4 DSRIP payments processed for transferring hospitals and top 14 IGT Entities.
• July 31, 2015 – April reporting DY2 and DY3 DSRIP payments processed for all providers and DY4 DSRIP payments processed for remaining providers that were not paid on July 21, 2015. Note that there are separate transactions for each payment for each DY.

If a provider has questions regarding the April DY4 reporting results, they should contact the Waiver mailbox at TXHealthcareTransformation@hhsc.state.tx.us.

Good Afternoon Region 10 Providers,

I have an update and a two reminders for you this afternoon.

Category 3 Compliance Monitoring

Attached is the final list of Category 3 baselines that were randomly selected by Myers and Stauffer for compliance monitoring.

Myers and Stauffer notified 10 selected Category 3 projects at the end of May (noted in column G of the attached file), and will notify the rest of selected providers by next week. Myers and Stauffer will then begin working with providers over the next several weeks on specific document requests.

Just like with mid-point assessment communications, HHSC emails about compliance monitoring will come from the DSRIP Compliance mailbox: TXHealthcareTransformationDSRIP_Compliance@hhsc.state.tx.us. Anchors and providers can send any questions about compliance monitoring to this mailbox as well.

Transformational Impact Summaries

Please remember that these are due to the RHP Mailbox(RHP_Region_10@jpshealth.org) by COB Friday, June 12^th. In a previous email the date was mistakenly June 14^th, sorry for any confusion.

April reporting NMI’s

RHP 10 providers should receive information from HHSC on any NMI’s by tomorrow, June 10^th.

Please let me know if you have any questions.

Good Morning Region 10 Providers,

I have an update and reminder for you this morning.

Waiver Renewal

• HHSC has posted a survey link on the HHSC website’s Waiver Renewal page for stakeholders to give preliminary feedback on the draft waiver renewal document discussed at the May 14^th Executive Waiver Committee meeting.  That document is also posted on the Waiver Renewal page. HHSC will be replacing that survey with another one when the official draft waiver renewal document is available in late June/early July in order to get feedback specific to the actual waiver renewal request.
• Here is the current survey link: https://www.surveymonkey.com/s/NMMSSLG

Reminders

RHP 9 & RHP 10 present

Collaborative Connections – Impacting Care

Learning Collaborative Event

The Hurst Conference Center

1601 Campus Drive

Hurst, TX 76054

Collaborative Connections - Impacting Care is a two day event highlighting the triple aim, 1115 waiver impacts on healthcare, waiver renewal activities, how to sustain the gain in your project, depression screening in primary care, integrated behavioral health and primary care, breakout sessions by project types and category 3 outcome measures, and more. 

Wednesday, May 27, 2015:  8:00 a.m. - 4:00 p.m.

Thursday, May 28, 2015:  8:00 a.m. - 4:00 p.m.

Sign-in & Breakfast: 8:00 a.m.

Program begins at 8:50 a.m.

Click RHP9 & RHP10 Collaborative Connections to Register for the Event.

Objectives: 

• Identify est practice care models through presentations and collaborative interactions with other providers
• Incorporate various process improvement tools in your projects to enhance outcomes and share your successes
• Create opportunities for networking amongst providers and community providers.

Please let me know if you have any questions.

• June 10, 2015 – HHSC and CMS will complete their review and approval of April reports or request additional information (referred to as NMI) regarding the data reported.
• July 2, 2015, 11:59pm – Due date for providers to submit responses to HHSC requests for additional information (NMI requests) on April reported Category 1‐4 milestone/metric achievement and Semi‐Annual Reporting requirements. Please include "NMI" in the file name when uploading documentation in response to NMI requests.
• July 8, 2015 – IGT due for April reporting DSRIP payments.
• July 21, 2015 – April reporting DY4 DSRIP payments processed for transferring hospitals and top 14 IGT Entities.
• July 31, 2015 ‐ April reporting DY2 and DY3 DSRIP payments processed for all providers and DY4 DSRIP payments processed for remaining providers that were not paid on July 21, 2015.
• August, 7 2015 – HHSC and CMS will approve or deny the additional information submitted in response to HHSC comments on April reported milestone/metric achievement.

May 04, 2015
DSRIP

• HHSC has added the DSRIP Statewide Events Calendar to the end of the Anchor Notes.  HHSC plans to update this calendar monthly and post it on the waiver website.

Good Morning Region 10 Providers,

I have lots of updates for you this morning! Please be sure to read that attached Anchor call notes. Also, attached is an updated draft of the DSRIP payment schedule for DY4-DY5.

DY 4 April Reporting

• HHSC posted a current list of projects with QPI issues that affect April DY4 reporting (similar to what was previously shared via email) on the Tools and Guidelines for Regional Healthcare Partnership Participants page of the Waiver website. Providers reporting QPI metrics for achievement during April DY4 should check this list prior to doing so.

• HHSC posted a revised DY4 QPI Reporting Template on the Tools and Guidelines for Regional Healthcare Partnership Participants page of the Waiver website. Projects with a template delay (listed in the list of projects with QPI issues document) may report using this version of the template. Providers with projects that did not have a template delay may continue to use the DY4 QPI Template posted prior to the update, if they already began using it.

• HHSC is prioritizing Waiver mailbox questions to first address issues that impact the ability to report during April DY4 reporting. When submitting a QPI question to the mailbox, please let us know if you intend to report the metric for achievement during April DY4 reporting. Also, please remember to include both your RHP and project ID numbers with your question.

Category 4

• Last Friday, HHSC updated the Category 4 April DY4 reporting template posted on the waiver website. The new template makes minor updates in the language for the qualitative questions for RDs 3 & 5. Providers may submit the original version of the Cat 4 DY4 template if needed, while responding to the revised qualitative questions.

• On April 3^rd, HHSC sent PPE reports for CY2013 to UC and DSRIP Category 4 participants for DY 4 reporting. Technical notes for CY2013 PPA, PPR, and PPC reports have been posted to the waiver website under resources for DY4 reporting. We understand updates made to the 2013 PPA and PPR reports make direct comparisons between the two reporting periods challenging, and are currently preparing additional guidance on qualitative responses for the Category 4 DY4 Reporting Template

Change Request Process

• In June, HHSC will provide an opportunity for 3-year projects to submit change requests for DY5 only.  Additional information will be forthcoming.

Mid-Point Assessment

• Myers and Stauffer (MSLC) continues the work for the mid-point assessment by reviewing 3-year projects. Many providers received questions from Myers and Stauffer, which unfortunately overlapped with the reporting period.

• HHSC is still working on changes to the metrics impacting DY5 and/or narratives, and may be still contacting providers about these changes. HHSC plans to complete this work by the beginning of May.

• As part of the mid-point assessment, HHSC will be requesting that projects that met or exceeded their DY5 QPI goal with DY3 QPI achievement increase their DY5 QPI goals. HHSC will contact impacted providers in May and cc Anchors with the proposed updated DY5 QPI goals.

• HHSC received results of the mid-point assessment review from MSLC and are in the process of finalizing our feedback. HHSC will share additional information regarding results of the review and next steps in the very near future

Waiver Renewal Planning

• HHSC plans to have a draft of the Waiver Extension/Renewal for public review in June 2015 and plans for public meetings in July 2015. They will communicate dates and locations as soon as available.

Value Based Payment Structure

• HHSC is reaching out to DSRIP projects and MCOs for examples and/or input in order to develop a model for implementing Value-Based Payments in Medicaid managed care. They are looking for good data and concrete steps that projects have used/are using for VBP arrangements with MCOs.

DSRIP Statewide Events Calendar

• In the future, HHSC will be sending a monthly statewide DSRIP events calendar along with the Anchor notes. They will also post the calendar on the waiver website.

• If you would like the Anchor office to review any of you April reporting information please let us know by sending an email to RHP_Region_10@jpshealth.org

• 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.

• HHSC is currently reviewing additional information submitted for provisionally approved metrics that received “Need More Information” (NMI) requests.
• HHSC will make final determinations and notify providers of results by March 31.
• If a provisionally approved metric is ultimately not approved, HHSC will inform the provider of the recoupment amount by mid-April. The provider will not be eligible for future payments until the recoupment occurs

Good Morning Region 10 Providers,

I wanted to send out a few quick reminders this morning.

October DY3 Reporting

• Providers with provisionally approved metrics marked “Need More Info” will need to submit additional supporting documentation to demonstrate achievement. These NMI submissions should be emailed to DSRIP@deloitte.com by 11:59 pm TODAY, March 6, 2015.  Please be sure to copy the RHP mailbox on your submissions.

Mid-point Assessment

• RHP 10 providers have received their additional questions from MSLC. The replies to the questions are due the MSLC by COB Thursday, March 12, 2015.

• Myers and Stauffer continues with the review of projects and sending questions to providers in cases when additional information is needed. If a provider does not receive a document with follow up questions from MSLC, the provider should not be concerned about this. It means that MSLC staff did not have additional questions for these projects. 
• In addition, MSLC started to review information reported for 3 year projects that did not have any information reported in April of 2014. MSLC may contact providers with additional questions regarding any of the 3-year project that reported in October, including projects in addition to those providers were notified had been selected by MSLC for review in September 2014.

Project Withdrawals

• HHSC wanted to make sure that providers understand that projects that withdraw during the Feb 1^st  – May 1^st window will no longer be eligible for payments after May 1^st. This includes any carryforward payments from DY2 and DY3 that have not been achieved or paid.

Change Requests

• HHSC sent HHSC's Round 2 preliminary determinations and Myers & Stauffer's Round 1 determinations to anchors/providers this week. Please be sure to review this spreadsheet  to make sure that final determinations for plan modifications are correct. If the RHP anchor or a provider has questions related to HHSC’s feedback, please send an email to the Transformation Waiver mailbox with the following subject line: “Change Request Question – RHP 10 – Project ID#.” 

Please let me know if you have any questions.

• HHSC wanted to make sure that providers understand that projects that withdraw during the Feb 1^st  – May 1^st window will no longer be eligible for payments after May 1^st. This includes any carryforward payments from DY2 and DY3 that have not been achieved or paid.

• Approved Baselines/Goal Corrections: to the waiver mailbox no later than Wednesday, February 25th
• Technical Assistance/Baseline Clarification Flags: HHSC will contact providers
• Missing Survey Administration Forms: to the waiver mailbox no later than Friday, February 27^th
• Carryforward Status/DY4 Carryforward Approval: to the waiver mailbox no later than Wednesday, February 25th

• Approved Baselines/Goal Corrections: to the waiver mailbox no later than Wednesday, February 25th
• Technical Assistance/Baseline Clarification Flags: HHSC will contact providers
• Missing Survey Administration Forms: to the waiver mailbox no later than Friday, February 27^th
• Carryforward Status/DY4 Carryforward Approval: to the waiver mailbox no later than Wednesday, February 25th

Good Morning Region 10 Providers,

I have a lot of very important information to share with you this morning. I have highlighted some of the main points from the attached anchor call notes.

October Reporting and Review

·         HHSC staff is in the process of reviewing Provisionally Approved metrics. For Provisionally Approved metrics that need more information, HHSC will request additional information in mid-February (target date is Feb. 16) and ask that the information be provided by early March (target date is March 6).

Category 3

·         HHSC is reviewing baseline data submitted during the October reporting period. Currently, HHSC is identifying projects that need technical assistance or clarification.

·         HHSC expects a large volume of projects needing technical assistance or clarification on their reported baseline rate, and will prioritize projects eligible to report their DY4 achievement in April based on their baseline measurement period.

·         Next week HHSC will send out a RHP summary of Category 3 projects to the anchors in an excel file that will identify:

o   projects for which HHSC does not currently have any baseline concerns, and their DY4/DY5 performance goals and measurement periods.

o   those providers that we will be reaching out to for TA/baseline clarification (for the reasons listed above) and

o   projects that did not report baselines in October of DY3, status of carry forward, and carry forward projects that have received approval from HHSC to report baselines using DY4 data

·         HHSC  will be asking anchors to share this information with their providers to ensure the status (reported or carried forward) is accurate as reflected in the DSRIP automated reporting system.

o   HHSC will include specific instructions and response deadlines (targeting February 20th) for how to communicate any concerns with reporting or carryforward status noted in this excel summary.

·         HHSC will begin contacting providers for technical assistance and baseline clarifications after this summary is distributed to anchors. As this is anticipated to be a significant workload for HHSC staff, please encourage providers to hold off on sending any questions related to their Category 3 baseline until they are contacted by HHSC. For most scenarios, we will have a standard form for making corrections to baseline data.

·         During the last week of February and first week of March, after all needed TA/baseline clarification has been conducted, HHSC will send to the Anchors a zipped file with a PDF document for each Category 3 project with a baseline summary (including measurement period, approved subsets, etc.), DY4/DY5 goals and measurement periods and incentive allocation per milestone in DY4 and DY5.

Change Request Process

·         HHSC is reviewing the Round 2 change request submissions and Myers & Stauffer is reviewing the Round 1 submissions that required their review. HHSC plans to send HHSC's Round 2 preliminary determinations and Myers & Stauffer's Round 1 determinations to anchors/providers by mid to late February.

DSRIP Mid-Point Assessment

·         Meyers and Stauffer has contacted the RHP 10 Anchor to schedule the AnchorEntrance call. This call is scheduled for  Wednesday February 25^th.

·         We have asked that each provider with a project in the mid-point assessment have 1 representative on the call.

·         Meyers and Stauffer indicated that the list of projects that will have on site visits will be sent out later this week.

·         Please be sure the check your spam, junk and deleted mail because other providers have indicated that the email from Meyers and Stauffer have not gone to their inbox.

Project Withdrawal Window

·         CMS approved the proposed timeframe of February 1, 2015 – May 1, 2015 for withdrawal of a project from DSRIP after the mid-point assessment per the PFM protocol.

·         To withdraw a project, providers should complete the attached Project Removal Form and submit it to the waiver mailbox.

·         Providers do not have to wait until the mid-point assessment process is complete.

Waiver Renewal Planning

·         The waiver Special Terms and Conditions (STCs) require two submissions to CMS related to waiver extension/renewal.

·          The first is a transition plan due to CMS by March 31, 2015 that must address the state's experience with the DSRIP pool, actual UC trends in the state and investment in value-based purchasing and other payment reform options.

·         Attached you will find a draft copy of the transition plan if you have any substantive suggestions or comments to the draft please send them to the RHP mailbox (info@rhp10txwaiver.com) by  5PM on Thursday February 12^th.

·         CMS requested additional information to which HHSC responded.

Good Afternoon Region 10 Providers,

I have some learning collaborative information to share with you and a few reminders.

Learning Collaborative Information

• Thank you to all providers who attended the DY 4 Learning Collaborative session 1 on January 22. The presentations and agenda is now posted on the RHP 10 website at /informationresources/learncollaborativeinfo.html

• The survey from our January 22 Learning Collaborative went out today. If you attended please take a few minutes to fill out this quick survey. Your feedback is important to making the learning sessions as applicable to providers as possible.

• If you enjoyed the DSRIP video from RHP 3 and would like to share it with your team here is the link https://www.dropbox.com/s/825ymu2gvzfmb1a/LC%20Presentation%20NRL.pptx?dl=0  In order to access the video you will need to download the PowerPoint then click on the wmv file. If you have any questions or trouble accessing the video please let me know.

• Save the date for our Learning Summit with RHP 9 May 27^th and 28^th. A calendar invite with additional information will be going out this week!

• Several other regions are hosting learning collaboratives in February and March.

• RHP 7 will host their Learning Collaborative on February 17^th.
• RHP 8 will be hosting their Learning Collaborative on February 19^th from 1PM-4PM.
• RHP 12 will be having their learning Collaborative February 26^th from 8AM to 5PM.
• RHP’s 11,13,16,19 will be hosting a Learning Collaborative on March 6^th for rural providers.
• Please let me know if you are interested in attending any of these events and I will send you registration information.

Important Reminders

October Reporting and Review

• For Provisionally Approved metrics that need more information, HHSC will request additional information in mid-February (target date is Feb. 16) and ask that the information be provided by early March (target date is March 6).

Category 3

• HHSC is reviewing baseline data submitted during the October reporting period and anticipates this process will require a couple of months to complete (target - end of February).

Change Request Process

• HHSC is reviewing providers’ responses to change request NMIs and plans to send HHSC’s determinations to anchors/providers in early February.

Mid-Point Assessment

• The review schedule may change to remaining site visits occurring in mid-February.
• Myers and Stauffer will update HHSC on the current RHP review schedule. We will update anchors when we receive this information from the compliance monitor.

Please let me know if you have any questions.

• Anchor Call notes from the 1/9/15 call
• The UC deferral letter stating that it has been lifted
• Reporting data by RHP
• Clinical Champions workgroups spreadsheet
• The behavioral health report from The Meadows Foundation

Good Morning Region 10 Providers,

I have a few updates for you this morning.

Learning Collaborative

The first learning session for DY 4 will be held at the Riley Center on January 22^nd. Registration for this event is now open! Please click Here to register and be sure to register everyone on your team who plans to attend. A draft agenda will be posted on the registration page soon.

Plan Modification Process

HHSC is reviewing providers’ responses to change request NMIs and plans to send HHSC’s determinations to anchors/providers in early February.

October Reporting Review

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.

DSRIP Mid-Point Assessment

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

• So far RHP 10 has not been contacted by Meyers and Stauffer for the mid-point assessment.
• Week of January 5th: RHPs 3,7,9,10,12,14 and 15 (tentative)

Please let us know if you have any questions.

Good Afternoon Region 10 Providers,

HHSC Rate Analysis has sent out additional information on the UC Schedule 3 Costs. Please see the below email and attached spreadsheet.

HHSC sent the message below on Friday to allow providers to recalculate the RCC in Schedule 3 of the tool, as well as to recalculate organ acquisition costs that had been overstated using the original methodology in the tool. HHSC has added a table to the recalculation workbook for providers to also calculate revised per diems that include the allowable interns and residents costs. Please complete the table using the data requested from your cost report, insert the revised per diems and RCC's into the corresponding fields in your tool, and re submit to HHSC.

Please note that this revised methodology only affects hospitals who incurred Interns and Residents costs and Organ Acquisition/ Transplant costs. It does not affect the majority of providers or any TXPUC providers.

Please be aware that if you claimed organ costs, the new methodology established for calculating these costs established in the attached workbook is mandatory, and must be utilized for all organ acquisition costs claimed in the tool. Only Medicaid organ related costs can be reimbursed in the DSH and UC programs.

Providers who are amending their tool based on the revised methodology do NOT need to submit a new certification with the amended tool and support. Providers also do not need to resubmit all of their supporting documentation, just documents that were amended in an email formatted as directed below.

HHSC is correcting the methodology for several issues that pertain to the HSL calculation in Schedule 3 of the DSH/UC Tool. Specifically, HHSC is correcting the following:

1. Erroneous instructions for calculating the ratio of costs to charges (RCC) for providers that had interns and residents costs that resulted in understated RCC: The instructions for completing the UC Tool gave providers the wrong direction for calculating a revised RCC that would have included the costs for interns and residents. If your hospital incurred these costs, please enter the total hospital costs from w/s B part I, column 24 (total cost before interns and residents costs are removed), as well as the charges from w/s C part I already submitted  into the corresponding cell in the “RCC Recalculation” tab in the attached workbook. This will produce a revised RCC that will need to replace the RCC currently in the tool. Please replace the RCC in the Cost Report Collection tab of your tool using the revised RCC and resubmit your tool and the workbook as support. Providers will also re-calculate their per diems to include interns and residents costs by taking days from w/s S-3 part I, col 8 (except for Adults and Pediatrics, which must come from w/s D-1, line 1), and dividing these days by costs from w/s B part I, column 24. Please take the revised per diems calculated in column H and copy and paste the revised amounts into the corresponding cells in your tool and resubmit.
2. Incorrect Organ Acquisition Costs resulting in overstated RCCs: The current functionality of the Tool does not calculate organ acquisition costs by using only eligible Medicaid organ costs that can be included for DSH and UC and using an RCC to calculate actual costs as it should. Instead, total organ acquisition costs are directly added to the HSL, which grossly overstates the allowable costs. HHSC has derived a new methodology for calculating the eligible costs relating to organ acquisition for providers to use to calculate their costs correctly. This calculation will rely on using the total cost and organs from w/s D part 4, and the number of Medicaid eligible organs which will come from paid claims data and/or provider records. Please enter the data requested in the headings of each yellow column in the “Organ Costs” tab. There are two sections to complete, one for in state costs, and one for out of state costs. Once all data has been entered, the revised organ costs will be calculated in cells D60-D67 of the “Organ Costs” tab. Please overwrite the cost for each organ in section 7.8 of the Hospital Application tab of your tool with the revised costs produced by the “Organ Costs” spreadsheet and resubmit your tool, supporting documentation for the Medicaid organs, and the “RCC_OrganCost Recalculation” workbook as support to HHSC.

If this revised methodology affects your hospital, please re-calculate your RCC and/or organ costs, and input the revised RCC and organ costs in the correct fields in your tool. Do not attempt to insert the new “Cost Report Collection” tab into your tool as this will break formulas. Simply copy and paste (values) the newly calculated RCC and organ costs into the appropriate fields in your tool. When resubmitting, please use “Resubmission, TPI, Hospital Name” as the format for the subject line in your email. The revised tool, calculation workbook, and supporting documentation for organ costs are due to HHSC by 5:00 p.m. Friday, December 19, 2014. If you are a consultant who must complete this for multiple hospitals and need additional time, please contact the UC Tools mailbox.

• Anchor Call Notes
• Category 3 Selections as of October 1, 2014
• Anchor Annual Report and Appendices
• UC Deferral Letter sent from HHSC to CMS
• UC Only Hospital Category 4 Tracker
• RCC UC Tool Recalculation

• HHSC will complete its October reporting review by today.  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 this 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. 15^th 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.

Good Morning Region 10 Providers,

Below you will find updated information from HHSC on the UC deferral.  Please let us know if you have any questions.

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.

• October reporting initial feedback is expected the week of December 8^th.

Good Morning Region 10 Providers,

Please see the email below and attachments. HHSC Rate Analysis has revised the DY 3 Advance payments and IGT amounts for each provider.

This e-mail revises the e-mail sent to you on November 14, 2014, and pasted below. 

The only difference between the November 14, 2014, e-mail and this e-mail is the attachment (in the documents library) "DY3 Advance UC Payments (Revised 11 25).xlsx".  This attachment should be substituted for the "DY3 Advance UC Payments (Final 11 14).xlsx" file that was attached to the November 14, 2014, e-mail.

The revised attachment differs from the original attachment in three ways:

1. It includes a small number of providers that were not included in the original attachment;
2. It corrects the public/private categorization of a small number of hospitals; and
3. It reduces the DY 3 Advance Payment Amount and DY 3 Advance IGT Amount for all providers.

IGTs to be submitted to TexNet by 12/4/14 must be based on the revised attachment, not the original attachment.

Values included in the original attachment were based on 50 percent of each provider's total DY 2 UC costs prior to any haircut.  Values included in the revised attachment are based on approximately 30.81 percent of each provider's total DY 2 UC costs prior to any haircut.  These revised values will limit the total DY 3 advance payment to 50 percent of the available DY 3 UC funds which will significantly reduce the likelihood of any recoupments due to violations of the various UC Pool caps when final DY 3 payments are calculated.

Final DY 3 UC payments are currently scheduled for April 2015; all remaining DY 3 UC funds will be allocated at the time that final DY 3 UC payments are determined.

We apologize for any disruption this revision may cause.

 Providers, Government Entities, and Anchors:

Please read this entire message carefully and make note of the information provided below that failure by IGT entities and providers to submit the required forms may result in a delayed payment for the providers. 

HHSC is providing notice to IGT for the DY3 Advance UC Payment.

Dates pertinent to this payment:

12/4/14                Last day to submit your IGT into TexNet

12/5/14                IGT Settlement date

12/15/14              Pay Transferring Hospitals

12/31/14              Pay all other UC Providers- Public entities will be paid as soon as possible after 12/15/14, with the private entities also being paid as soon as possible but no later than 12/31/14.

Attached to this email are the following documents:

• the DY 3 Advance UC Payment spreadsheet;
• the Master Affiliation as of 11_14_14 for Distribution spreadsheet;
• Learning Collaborative Certification;
• Category 4 Reporting Certification Form
•  the DY3 Advance UC Allocation Form

Pursuant to §354.1633(e) a UC hospital must participate in an annual learning collaborative and report on a subset of Category 4 measures. The attached certification forms are required by all hospitals to be eligible for DY 3 UC Payments. Please complete the forms and email a signed pdf copy to uctools@hhsc.state.tx.us by December 4, 2014.

Government Entities that are IGT'ing for multiple providers may submit one lump sum IGT for everyone.  However, HHSC requires that if you are submitting IGT for multiple providers you must complete the attached DY3 Advance UC Allocation form. This will provide the HHSC Rate Analysis Department necessary information to allocate and apply the lump sum IGT to each provider. You can identify the affiliation number for the provider that you are IGT'ing for on the Master Affiliation as of 11_14_14 for Distribution spreadsheet.

Once you have entered your IGT into TexNet you will receive a receipt that HHSC refers to as the Trace Sheet. HHSC asks that ALL IGT'ing entities send their Trace Sheets and Allocation Forms to the UC Tools mailbox at uctools@hhsc.state.tx.us .  Please designate your funds into the appropriate bucket, UC Hospital (for hospitals) or UC Physician (for physicians).  If you have any questions or require any assistance, please send a message to the UC Tools mailbox.

• UC-only hospitals will need to certify by December 4^th that they have met the learning collaborative requirement in order to receive the DY3 advance UC payment. 

• Mid-point Assessment:
  • Many regions have been already contacted by Myers and Stauffer LC and scheduled entrance conferences.
  • Some regions will be contacted in the near future. We understand that with upcoming holidays even preliminary schedule may be helpful for planning purposes, so we wanted to share a tentativeschedule for onsite visits (and most likely entrance conferences) for the remaining regions.
    • Week of December 1^st: RHPs 1 and 18
    • Week of December 15^th: RHPs 2, 4, and 5 (all tentative)
    • Week of January 5^th: RHPs 3,7,9,10,12,14 and 15 (all tentative)
    • Week of January 19^th: RHP 6 (tentative)

1. Hospitals that receive Uncompensated Care payments are required to report on a subset of DSRIP Category 4 measures. The subset includes:      Potentially Preventable Admissions (PPAs); Potentially Preventable Readmissions (PPRs); and Potentially Preventable Complications (PPCs). Category 4 reporting begins in DY 3 for PPAs and PPRs and in DY 4 for PPCs and continues through DY 5. (Please note that certain hospitals are exempt from Category 4 (refer to paragraph 11.f.).  

Good Afternoon Region 10 Providers,

As was mentioned in the plan modification email sent out the is morning, HHSC has posted the updated workbooks on their website at http://www.hhsc.state.tx.us/1115-round-1-P-D.shtml. Please be sure to double check these workbooks for updates that were made to your projects from the approved plan modifications.  Please note that 3-year projects have a separate file from the RHP 10 file containing 4-year projects. Both of these files are in the documet library for your reference. Please remember that any changes that were made by HHSC will be highlighted in green.

Please let me know if you have any questions.

Good Afternoon UC Hospitals,

Many of you have asked about the Category 4 certification and the measures that were to be reported. I have heard from HHSC that UC only providers just need to send in the Category 4 certification and do not need to send the measures. I have put the email from HHSC below for your reference.

Please let me know if you have any questions.

1. The first tab summary information shows a summary for the entire region on what was approved, approved with HHSC changes, not approved, or needs more information.  
2. The second tab shows the summary broken down by provider.
3. The third tab is the data from the original HHSC file but made to be user friendly with filters and conditional formatting.

Good Afternoon RHP 10 Providers,

I have several very important pieces of information to share with you this afternoon and a few reminders!

Statewide Navigators Call

• I know that several providers joined the Navigators call last Thursday. The coordinator of the call is asking that any interested providers use this survey link to enter information about your program so that we can create a master list of the programs going on around the state this will be distributed to facilitate opportunity for future conversation and collaboration. http://survey.constantcontact.com/survey/a07ea4rnl2yi2hqw3td/start
• The notes from this call are also attached.

RHP 10 Financial Overview

• Attached you will find a financial overview for October DY 3 Reporting for RHP 10. Please review this document for accuracy and let me know if any updates need to be made by Friday November 21^st, at 5PM.
• All of the DY 3 October reporting information came from the online reporting tool.

Reminders

• The waiver renewal survey for HHSC is due by November 26^th. HHSC has encouraged (but not required) providers to fill out the survey as a group if at all possible. Here is the link http://goo.gl/forms/vDC0RuuY5e.
• The Anchor Survey for DY 2 Unspent Funds is due to the RHP mailbox info@rhp10txwaiver.com by 5PM TODAY.

UC Providers and Hospitals

• HHSC Rate Analysis provided the below information on the DY3 Advance UC Payment/IGT Notification.

HHSC is providing notice to IGT for the DY3 Advance UC Payment.

Dates pertinent to this payment:

12/4/14                Last day to submit your IGT into TexNet

12/5/14                IGT Settlement date

12/15/14              Pay Transferring Hospitals

12/31/14              Pay all other UC Providers- Public entities will be paid as soon as possible after 12/15/14, with the private entities also being paid as soon as possible but no later than 12/31/14.

In the document library are the following documents:

• the DY 3 Advance UC Payment spreadsheet;
• the Master Affiliation as of 11_14_14 for Distribution spreadsheet;
• Learning Collaborative Certification;
• Category 4 Reporting Certification Form
•  the DY3 Advance UC Allocation Form

Pursuant to §354.1633(e) a UC hospital must participate in an annual learning collaborative and report on a subset of Category 4 measures. The attached certification forms are required by all hospitals to be eligible for DY 3 UC Payments. Please complete the forms and email a signed pdf copy to uctools@hhsc.state.tx.us by December 4, 2014. Please cc the RHP 10 box (info@rhp10txwaiver.com) on this email also.