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Funding Impact of the 1115 Transformation Waiver
RHP 14 Learning CollaborativeJuly 18, 2014
Kevin Nolting Consulting
Recent Information on DY 3 UCC Funding Activities: HHSC has developed the Texas Hospital Uncompensated Care (TXHUC)
application, a combined DSH and UC application for FFY 2014 (DY 3) This application will serve two purposes
HHSC will be using information in the application to conduct the interim reconciliation for all providers that received a FFY 2011 Demonstration Year (DY 1) UC payment as required under the CMS UC Waiver Claiming Protocol.
All providers that wish to participate in the FFY 2014 DSH and/or in the DY 3 UC program have to complete and submit the application.
◦ Providers wanting to participate in the FFY 2014 DSH program and/or the DY 3 UC program must complete the TXHUC to be eligible.
◦ Providers who received DY 1 UC payments must complete the form or will be subject to recoupment of all DY 1 UC payments
◦ HHSC deadline for requesting a copy of the TXHUC is July 23, 2014.◦ A hospital that fails to request a TXHUC by the deadline will not be eligible
to participate in the 2014 DSH and DY 3 UC programs or to appeal HHSC's non-qualification decisions.
◦ No published estimate of future program funding dates.
Current Status of UCC Funding
Recent Information on DY 2 UCC Funding Activities:◦ HHSC distributed $3.9 Billion in DY 2 UCC payments (total allocation)◦ Statewide committed IGT would have paid $4.9 Billion◦ Resulted in a 21.7% haircut to remain within DY 2 UCC Pool allocation◦ Total UCC costs reported was $5.9 Billion
Current Status of UCC Funding
The following are funding questions that need to be addressed collaboratively between HHSC and the Waiver participants:
• Allocation of dwindling UC Pool.• Future impact on indigent care affiliations due to
reduced UC Pool and future “haircuts”.• Impact of the outcome of HHSC Rider 86.• Impact of future changes related to the Affordable
Care Act. • Status of DSH funding for future years.• Prepare for negotiations on Waiver renewal and
strategies for successful outcomes.
Funding Implications
Current Waiver Pool Allocations
Allocation of Dwindling UC Pool
Type of Pool
DY 1 (2011-2012)
DY 2 (2012- 2013)
DY 3 (2013- 2014)
DY 4 (2014-2015)
DY 5 (2015-2016)
Totals
UC 3,700,000,000 3,900,000,000 3,534,000,000 3,348,000,000 3,100,000,000 $17,582,000,000
DSRIP 500,000,000 2,300,000,000 2,666,000,000 2,852,000,000 3,100,000,000 $11,418,000,000
TOTAL/DY 4,200,000,000 6,200,000,000 6,200,000,000 6,200,000,000 6,200,000,000 $29,000,000,000
% UC 88% 63% 57% 54% 50% 60%
% DSRIP 12% 37% 43% 46% 50% 40%
UPL Est.(Inflated 3% per year)
2,873,236,484 2,959,433,578 3,048,216,585 3,139,663,083 3,233,852,976 $15,254,402,706
Allocation of Dwindling UC Pool
UPL Program
FY 2011
DY 1 (2011-2012)
DY 2 (2012- 2013)
DY 3 (2013- 2014)
DY 4 (2014-2015)
DY 5 (2015-2016)
Totals (DY 1-DY5)
Private 1,488,282,533 1,532,931,009 1,578,918,939 1,626,286,508 1,675,075,103 1,725,327,356 8,138,538,915
Large Urban 1,021,243,839 1,051,881,154 1,083,437,588 1,115,940,716 1,149,418,937 1,183,901,506 5,584,579,901
State 93,165,689 95,960,659 98,839,479 101,804,664 104,858,804 108,004,568 509,468,174
Rural 81,135,922 83,569,999 86,077,099 88,659,412 91,319,195 94,058,770 443,684,475
Children’s 34,899,942 35,946,940 37,025,348 38,136,109 39,280,192 40,458,598 190,847,186
Physician’s 70,822,060 72,946,722 75,135,124 77,389,178 79,710,853 82,102,179 387,284,056
Total 2,789,549,984 2,873,236,484 2,959,433,578 3,048,216,585 3,139,663,083 3,233,852,976 15,254,402,706
Historical UPL Expenditures Projected
Impact on IGT of Haircut
Scenarios on Impacts on IGT resulting from a Haircut
Description Scenario A (No Haircut)
Public
Scenario A(No Haircut)
Private
Scenario B(20%
Haircut) Public
Scenario B (20%
Haircut)Private
Scenario C(40%
Haircut) Public
Scenario C(40%
Haircut)Private
UC Payment/IGT Calculation:
UC Cap 16,000,000 16,000,000 16,000,000
Haircut (Scenario B - 20%) N/A 20% 40%
Revised UC Cap Eligible for IGT 16,000,000 12,800,000 9,600,000
Indigent Care/Expense Alleviation 10,000,000 (10,000,000) 10,000,000 (10,000,000) 6,000,000 (6,000,000)
UC Payment to Private Hospital 15,000,000 12,800,000 8,750,000
IGT from Public to Private for UC (6,000,000) (5,100,000) (3,500,000)
Amount for Additional Services/UC 4,000,000 5,000,000 4,900,000 2,800,000 2,500,000 2,750,000
Impact on IGT of Haircut
