Medicaid 1115 Waiver Payments

Overview

The General Appropriations Act, 85th Legislature, R.S., Art. II, at II-104 (HHSC, Rider 23) requires the Health and Human Services Commission (HHSC) report specified information regarding all funds distributed for uncompensated care (UC) and Delivery System Reform Incentive Payments (DSRIP) under the 1115 Medicaid Transformation Waiver to the Legislature and the public.

Waiver Payment Forms for UC/DSRIP Providers

1115 Waiver Uncompensated Care (UC) Reconciliation

View UC Reconciliation information

1115 Waiver Uncompensated Care (UC)

View Proposed UC Timeline for Payments (.pdf)

Uncompensated Care Payments

1115 Waiver Delivery System Reform Incentive Payments (DSRIP)

View Proposed DSRIP Timeline for Payments (.pdf)

Delivery System Reform Incentive Payments (DSRIP)

1115 Waiver/Rider 22 Reporting for UC and DSRIP

Rider 22 Reporting for Uncompensated Care (UC) Payments:

View UC payments (January 2019 - March 2019) made under the 1115 Waiver (.pdf)

View UC payments (December 2018) made under the 1115 Waiver (.pdf)

View UC payments (September - October 2018) made under the 1115 Waiver (.pdf)

View UC payments (June 2018) made under the 1115 Waiver (.pdf)

View UC payments (February - March 2018) made under the 1115 Waiver (.pdf)

View UC payments (November 2017) made under the 1115 Waiver (.pdf)

View UC payments (October 2017) made under the 1115 Waiver (.pdf)

View UC payments (February 2017) made under the 1115 Waiver (.pdf)

View UC payments (January 2017) made under the 1115 Waiver (.pdf)

View UC payments (October 2016) made under the 1115 Waiver (.pdf)

View UC payments (September 2016) made under the 1115 Waiver (.pdf)

View UC payments (April-May 2016) made under the 1115 Waiver (.pdf)

View UC payments (March 2016) made under the 1115 Waiver (.pdf)

View UC payments (February 2016) made under the 1115 Waiver (.pdf)

View UC payments (November - December 2015) made under the 1115 Waiver (.pdf)

Rider 22 Reporting for Delivery System Reform Incentive Payments (DSRIP):

View DSRIP payments (July 2019) made under the 1115 Waiver (.pdf)

View DSRIP payments (March 2019) made under the 1115 Waiver (.pdf)

View DSRIP payments (January - February 2019) made under the 1115 Waiver (.pdf)

View DSRIP payments (September 2018) made under the 1115 Waiver (.pdf)

View DSRIP payments (July - August 2018) made under the 1115 Waiver (.pdf)

View DSRIP payments (March 2018) made under the 1115 Waiver (.pdf)

View DSRIP payments (January - February 2018) made under the 1115 Waiver (.pdf)

View DSRIP payments (November 2017) made under the 1115 Waiver (.pdf)

View DSRIP payments (October 2017) made under the 1115 Waiver (.pdf)

View DSRIP payments (August 2017) made under the 1115 Waiver (.pdf)

View DSRIP payments (July 2017) made under the 1115 Waiver (.pdf)

View DSRIP payments (February 2017) made under the 1115 Waiver (.pdf)

View DSRIP payments (January - February 2017) made under the 1115 Waiver (.pdf)

View DSRIP payments (October 2016) made under the 1115 Waiver (.pdf)

View DSRIP payments (September 2016) made under the 1115 Waiver (.pdf)

View DSRIP payments (July - August 2016) made under the 1115 Waiver (.pdf)

View DSRIP payments (March 2016) made under the 1115 Waiver (.pdf)

View DSRIP payments (January - February 2016) made under the 1115 Waiver (.pdf)

Hospital Payment Modeling

Supplemental payments have gone through changes in past years and the Uncompensated Care methodology will change in October 2019. To inform stakeholders, HHSC is providing extensive, detailed modeling concerning many of these payment programs. The data provides information about possible future payments and fosters discussions among the stakeholders regarding multiple outstanding issues.

If you have questions or feedback, please send them to RAD_1115_Waiver_Finance@hhsc.state.tx.us. The deadline is June 14, 2019 to provide feedback for the Withheld Uncompensated Care Payments for Demonstration Years 3-6 and Upper Payment Limit Obligation.

Overview of Modeling

Omnibus HHSC Hospital Payment Modeling Information  (.pdf) 04/25/2019

Questions and Answers related to the models

Hospital Payment Modeling Questions and Responses (.pdf) 06/14/2019
Updates to the “Hospital Payment Modeling Questions and Responses” document typically posted every Wednesday will now occur every Thursday, effective immediately. Thank you in advance for your understanding.

HHSC Models

1. Demonstration Years 9-11 Uncompensated Care Distribution at Multiple Pool Sizes and HSLs, by Deloitte. Associated file names:

UC.DSH.UHRIP Impact Assessment (.pdf) 06/12/2019
TX UC DSH UHRIP Payment Model Data Refresh (.xlsx) 06/12/2019
UC.DSH.UHRIP Impact Assessment (.pdf) 04/23/2019
TX UC DSH UHRIP Payment Model Data Refresh (.xlsx)
UC.DSH.UHRIP Impact Assessment Final (.pdf) 10/30/2018
DY 9 UC S-10 Data Collection (.xlsx)

2. Hospital Specific Limit Methodology for Hypothetical 2017 Compared to SB7 Methodology, by Deloitte. Associated file names:

UC.DSH Impact of HSL Changes Assessment (.pdf)

3. Combined Withheld Uncompensated Care Payments for Demonstration Years 3-6 and Upper Payment Limit Obligation. Associated file names:

UC Withheld Decision Tree (.pdf)
Final UC Withheld and UPL Obligation Allocation (.xlsx)
Final UC Withheld and UPL Obligation Allocation (Updated) (.xlsx) 05/13/2019
Change Log for Final UC Withheld and UPL Obligation Allocation (.pdf)

DY 1 UC Expenditure (.xlsx)
DY 2 UC Expenditure (.xlsx)
DY 3 UC Expenditure (.xlsx)
DY 4 UC Expenditure (.xlsx)
DY 5 UC Expenditure (.xlsx)

DY 3 UC Option 1 (.xlsx)
DY 3 UC Option 2 (.xlsx)
DY 3 UC Option 3 (.xlsx)
DY 4 UC Option 1 (.xlsx)
DY 4 UC Option 2 (.xlsx)
DY 4 UC Option 3 (.xlsx)
DY 5 UC Option 1 (.xlsx)
DY 5 UC Option 2 (.xlsx)
DY 5 UC Option 3 (.xlsx)
DY 6 UC Option 1 (.xlsx)
DY 6 UC Option 2 (.xlsx)
DY 6 UC Option 3 (.xlsx)

4. Fiscal Year 2011 UPL Expenditures

Fiscal Year 2011 UPL Expenditures (.xlsx) 05/01/2019

5. Sizing Methodology Estimate UC Pool

CMS Sizing Methodology with FYB 2017 S-10 Data (Actual Pool Size) (.xlsx)