Embed Size (px)
Citation preview
FRIDAY, MAY 18 , 2018
10:00AM– 11:00AM
MCH CENTER FOR HEALTH AND WELLNESS
David Garcia
FHC Executive Director/Director of Governmental Affairs
Medical Center Health System
RHP 14 welcomes back Martin County Hospital District!
1. Culberson County Hospital District
2. Ector County Hospital District
3. Martin County Hospital District
4. Midland County Hospital District
5. Odessa Regional Medical Center
6. Permian Basin Community Centers
7. Permian Regional Medical Center
8. Reeves County Hospital
9. Texas Tech University Health Sciences Center
10. Winkler County Memorial Hospital
Texas 1115 Healthcare Transformation Waiver was originally approved by CMS in December 2011 to achieve three goals:
Preserve supplemental payments under a new methodologyExpand Medicaid managed care statewideTransform patient care delivery through innovative projects that advance the Triple Aim of
Healthcare
Most recent extension for 5 years was approved December 2017
UC funding levels stay constant for 2 years; subsequent years will be determined based on provider charity care data reported on Worksheet S-10 of the hospital’s Medicare cost reportDSRIP funding levels stay constant for 2 years, followed by two years of decreased funding, and zero
funding in the fifth year
Pool Allocation According to Demonstration Year
Demonstration Year DY7 DY8 DY9 DY10 DY11
DSRIP $3.1 Billion $3.1 Billion $2.91 Billion $2.49 Billion $0
UC $3.1 Billion $3.1 Billion $2.33 Billion* $2.33 Billion* $2.33 Billion*
*UC Pool limit amounts for DY9-11 are placeholder amounts pending assessment of hospital uncompensated charity care.
Updated protocol approved for DY7-8 (DY9-11 TBD)
Builds on current DSRIP project structure• Individual projects evolve into larger, system-level initiatives and targeted clinical outcomes
Focus remains on target population: Medicaid recipients and low-income uninsured individuals Continues advancing the Triple Aims of Healthcare Clinical outcomes and quality standards remain priorities Promotes collaboration for organizations who share patients
The baseline year for Category C measure bundles and measures is Calendar Year 2017. HHSC will be accepting early reporting of baselines in July-August 2018. Regular reporting period will be October 2018.
October 2018 Reporting PeriodDY6 DY7
Any remaining DY6 carryforward Category A – Required Reporting (0%)
Category B – MLIU and PPP (10%)
Category C – Baselines and Innovative Measures (55% or 65%)
Category D – Statewide Reporting Measure Bundle (15% or 5%)
Category C Baseline Template
published by HHSC
Category C baseline
reporting webinar
Category C Baseline Early
Reporting Templates due
to HHSC
HHSC sends notice of technical assistance
needed
As a condition of the CMS approval of the Waiver Extension, HHSC must develop andimplement a revised UC protocol methodology. Beginning in DY9, UC reimbursements toproviders will be based exclusively on uncompensated costs for certain charity services.
CMS and Texas have agreed UC Pool limits for DY 9-11 will be based on the amount of charity care provided by Texas hospitals as reported on Worksheet S-10 of the CMS 2552-10 cost report.
Starting in DY 9, charity care data reported on Worksheet S-10 will also be used to determine each hospital’s share of the statewide UC Pool.
The draft revised UC Protocol was submitted to CMS on March 29, 2018.
On May 1, 2018, HHSC posted draft rules addressing UC reimbursement for providersbeginning DY 9.
Major changes include:
Worksheet S-10 will be used to calculate each hospital’s maximum UC amount.
Physician, ambulance, and dental pools are limited to the proportional share of funds received inDY6.
Rider 38 hospital protections are removed in DY9.
Medicaid enrollment and billing requirements, as well as penalties for not meeting Category 4reporting requirements for UC-only hospitals, have been eliminated.
HHSC plans to exclude commercial and Medicare payments on Medicaid-eligible accountswhen calculating the HSL for both the 2018 DSH and UC programs.
HHSC will not withhold 3.5% of the DSH pool and 5% of the UC pool as it has in prior years.
Payment and IGT notifications are expected in August 2018, and UC payments are scheduledfor the end of September 2018. Each hospital’s final payment will be the difference betweenthe Advance DY7 payment received in February and the total entitlement for the year.
HHSC will only exclude commercial payments (not Medicare) on Medicaid-eligible accountswhen calculating entitlement to the DSH and UC funds withheld during DY3 through DY6.
Deadline for Anchor to
submit templates to
HHSC
HHSC reviews draft
templates & may request
additional info
HHSC approves
RHP Plan Updates
Providers receive 20%
of DY7 valuation
CHNA Priorities IdentifiedAccess to affordable care and reducing health disparities among specific populations.Access to mental and behavioral health care services and providers.Access to primary care services and providers.Access to specialty care services and providers.Need for increased emphasis on a collaborative continuum of care.Prevention, education and services to address high mortality rates, chronic diseases, preventable
conditions and unhealthy lifestyles.
Other Important Issues Identified by StakeholdersEffect of regional oil-driven economy on healthcare organizations and the patient population (vis-à-
vis shifts in patient population, increased cost of living, etc.)
A1: Chronic Disease Mgmt – Diabetes (5)
A2: Chronic Disease Mgmt-Heart Disease
B1: Care Transitions & Hosp. Readmissions
C2: Primary Care Prevention – Cancer
Screening
D1: Pediatric Primary Care
E1: Improved Maternal Care
E2: Maternal Safety (2) G1: Palliative Care I1: Specialty Care J1: Hospital Safety (2) K1: Rural Preventative Care (3)
K2: Rural Emergency Care
M1-105: Preventative Care and Screening –
Tobacco Use: Screening and Intervention
M1-115: Comprehensive Diabetes Care:
Hemoglobin A1c (HbA1c) Poor Control
(>9.0%)
M1-147: Preventative Care and Screening:
Adult Body Mass Index (BMI) Screening and
Follow-up
M1-211: Weight Assessment and
Counseling for Nutrition and Physical Activity for
Children/Adolescents
Multiple Stakeholders have expressed interest in coordinating cohort meetingswhere members with the same bundle can share ideas on how to improve theirrespective projects or figure out how to work collaboratively on a project.Projects chosen with overlaps include:
A1: Texas Tech, Odessa Regional, MCH, Permian Regional, Midland MemorialE2: Odessa Regional, MCHJ1: MCH, Odessa RegionalK1: Culberson, Reeves, Winkler
The RHP 14 Anchor plans to conduct a face-to-face Learning Collaborative in July 2018 atMedical Center Health System in Odessa, TX. A second face-to-face learning collaborative istentatively scheduled for September 2018, contingent on feedback and interest expressed bystakeholders during the demonstration year.
Topics identified as of interest to regional stakeholders include:
DSRIP Integration into Medicaid Managed CareSustainability Strategies for Low-Income UninsuredGeneral Waiver/UC EducationS-10 EducationExpansion of services into remote areas of West TexasBlock GrantsProject SustainabilityMental Health Provider ShortagesIssues Affecting Small HospitalsImprovement Design Best Practices
At least three stakeholders expressed interest in presenting at a future learningcollaborative event. The RHP 14 Anchor will be reaching out to those stakeholdersshortly.
Stakeholder proposals for Learning Collaborative events may also be submitteddirectly to the Anchor at [email protected] subject line “RHP 14 LearningCollaborative Proposal.”
Quarterly web-based meetings
Regular email correspondence
Executive Committee
David GarciaFHC Executive Director/Director of Governmental Affairs
(432) 640-4868
