Waiver
THOT is working on a Waiver II concept to help retain Texas waiver funding. Texas Community Reform and Access Engagement (T-CARE) proposes to ask CMS to allocate waiver funding from amounts CMS would otherwise take from UC and DSRIP in Waiver II and invest in integrated systems of care. Under the proposal, providers both public and private, with an integrated delivery system capacity including outpatient preventive, primary, specialty, ancillary and inpatient services as well as care coordination and community based organization partnerships could access these “saved” waiver funds. Care would be provided to uninsured Texans in a coordinated way while providers invest in infrastructure to participate as value-based and value-driven community care providers and care integrators for uninsured Texans. THOT’s concept evolved out of work at our June 2015 Board meeting with national experts Barbara Eyman and Dianne Heffron.
THOT has had several conversations with CMS and with HHSC leadership assessing the viability of the proposal as a way to “double down” on Waiver I investments and invest in transformed, provider-based systems of care.
On July 20, THOT will join several other groups in a meeting with a broad range of HHSC staff to discuss proposed waiver innovations. On July 26, HHSC and HMA (the HHSC contractor performing the waiver Uncompensated Care report required by CMS) will meet with the THOT-facilitated Multi-Association Waiver Workgroup to discuss the UC Study.
Medicaid Financing
Texas hospital financing is facing changes and challenges from the CMS’ waiver principles (UC and DSRIP comprise about 40% of Texas Medicaid hospital financing), and new Medicaid managed care rules. Loss of waiver funding without alternate funding such as provider fees will result in budget shortfalls and service cuts for many THOT members. THOT provided testimony to this effect at County Affairs last month, and called for developing integrated provider networks under the waiver. Dr. Fred Cerise, THOT Chair and President and CEO of Parkland Health Systems, will represent THOT, providing invited testimony at a House Appropriations Article II (Health) Sub-committee hearing on July 13th, sharing system challenges and recommendations.
HHSC has been holding QIPP or Quality Improvement Payment Program workgroup meetings to develop a plan to continue with this program designed to increase quality and funding in nursing facilities. Several THOT members participate and see value in having access to SNF beds for uninsured Texans who would otherwise not have access and would be kept in a hospital setting. CMS’ new rules, in particular a no “Pay to Play” mandate has altered how the state plans to operate supplemental programs like QIPP. The no “Pay to Play” mandate basically means that CMS will not allow supplemental programs in which providers need to independently access IGT. The current DSH approach in which the state collects IGT and distributes it statewide is not problematic, but the ways in which IGT is currently accessed in programs like UC and DSRIP, are being challenged in programs outside the waiver such as QIPP and the Network Adequacy Improvement Program. The risk is that the state might adopt a “DSH-like” IGT approach with IGT entities contributing to statewide distribution programs. That would increase pressure on IGT entities for more funding for supplemental provider programs statewide.
See also: THOT’s Medicaid Financing Powerpoint from the June 24th Board Meeting; and our “Medigeddon” article for more information on these converging pressures in Texas. See also a recent article on Parkland’s budget process and current projected shortfall.
Trauma
The Texas Smart-On-Crime Coalition, a group of entities seeking to repeal the Drivers Responsibility Program (DRP) has been meeting with THOT and THA with a goal of resolving their concerns with the DRP. THOT and THA are working together to ensure there is no repeal of the DRP without a sum certain source of funding for trauma.
THOT is also planning a THOT Trauma Day at the Capitol on February 28, 2016. We plan to have posters and videos highlighting the importance of trauma funding as well as a repeat of our popular THOT Trauma break to educate. Plan to contribute and/or be there.
Women’s Health Coalition and Zika
THOT is a member of the WHC Coalition. Recently WHC asked Commissioner Smith to have Medicaid cover insect repellent to help prevent Zika. The Commissioner is working to efficiently offer this benefit for women in the Women’s Health program without having them obtain a prescription.
THOT Strategic Plan and Memberships
We presented a preliminary strategic plan at the Board meeting identifying three areas of excellence for THOT and our core focus areas. Our three areas of excellence are: Policy, Financing and Association Leadership; Advocacy; and Member and public communications. Our core focus areas include: Waiver Renewal, System Transformation, Coverage Options and Medicaid financing (which all overlap); Trauma and disaster preparedness; GME; 340B; Sociodemographic impacts on Essential Safety Net providers; and an outlier, but important and successful initiative on OIG coding issues.
We believe having the “best and brightest” resources in our three areas of excellence either with staff or contracted expertise is critical to THOT achieving our mission. Sustainability is also critical. We shared data on other hospitals and entities with possible overlapping missions to THOT’s. We proposed seeking members and affiliates that could include: full voting members that fully share THOT’s mission; non-voting affiliate members with entities that may share components of THOT’s mission and with which we can jointly collaborate on shared goals and objectives components of our mission; and Coalition members, for example a GME coalition of teaching hospitals with which we can partner to support Graduate Medical Education and financing in Texas.
The Board agreed to a bylaw change to allow affiliate memberships with rights and responsibilities to be determined by the Board upon membership approval. Please let us know your thoughts and if you have in mind hospitals or other entities that you think could be THOT members, affiliates or coalition members.
