1115 waivers must be budget neutral; i.e., not cost more than if there had been no waiver. States predict what their costs in Medicaid would have been if there was no waiver and compare those to estimates of Medicaid costs if there IS a waiver. The difference is the estimated waiver savings. These savings come…

It’s anyone’s guess what the election results mean for Texas’ 1115 waiver renewal. Just prior to the election, Commissioner Smith gave updates to THOT as well as the Executive Waiver Committee on HHSC/CMS waiver talks. Here’s where things were as of November 7th: CMS intends to decrease UC and DSRIP pool amounts in a waiver…

Lung Therapeutics, Inc. is a pharmaceutical company that targets niche orphan drug indications for lung injury and disease with an emphasis on fibrosis. The company was founded in 2012 with initial support by the University of Texas Horizon Fund by Dr. Steven Idell (Sr. VP of Research & Graduate Studies and Dean of the School…

Following last month’s Newsletter reported waiver trifecta: UC report release; disallowance; and request for Texas to resubmit its 1115 waiver; this past month has been relatively calm. We do have some answers to some of the trifecta issues while HHSC is in preparation mode in advance of face to face waiver negotiation meetings with CMS…

Senate Committee on Health and Human Services On September 13th, under Chair Charles Schwertner, the Senate Health and Human Services Committee held a lengthy hearing on its interim 1115 waiver charge[1], taking testimony from HHSC agency staff, Waiver Anchors and providers, health care advocates, and policy organizations. Discussion focused on the impact of Medicaid expansion…

Key HHS Legislative Appropriations Request (LAR) Update: the Budget The Department of State Health Services (DSHS)’s LAR contained a trauma funding surprise. The Legislative Budget Board and Governor’s Office of Budget Planning held an LAR Hearing for Health and Human Services on September 22nd. Prior to the hearing, THOT’s advocacy director spotted a trauma funding error, and spoke…

The month of August ended and September began with two wild and unexpected 1115 Waiver Weeks including three key waiver events. Following CMS & Office of Management and Budget visits to Texas’ Statewide Learning Collaborative (SLC), the state released  HMA’s Texas Uncompensated Care Report. Shortly thereafter HHSC received notice of  CMS’ surprise disallowance of $26.8…

What’s UP: NAIP, MPAP, QIPP Several THOT providers have invested in new Medicaid Supplemental programs – NAIP; MPAP/QIPP — to fund improved care and support their ability to continue providing services within Medicaid’s underfunded program. However, with CMS’ new Medicaid managed care rules, CMS working from its waiver principles, and the waiver hanging in the…

Finance Dr. Fred Cerise of Parkland and THOT provides testimony on hospital finance and the 1115 Waiver to the Texas House Appropriations Committee on behalf of THOT. July 13, 2016 Pass-Through Payments One option for new Medicaid funding opened up with CMS’ recently published Medicaid managed care rules. THOT’s June Board meeting focused on the…

Bottom Line: The Independent Study on Texas UC compares Texas’ UC/DSH Data with Medicare S10 data and Texas Department of State Health Services Hospital Data: S10 shows lower UC. Providers argue S10 data is not as accurate or reliable. THOT argues IGT should be included in the Study; otherwise UC funding to providers is overestimated….