DSRIP Program Funding and Mechanics Protocol

The Texas DSRIP Program Funding and Mechanics Protocol (PFM) is incorporated in the Texas Healthcare Transformation and Quality Improvement Program as Attachment J. The PFM provides the groundwork for HHSC and CMS to achieve the shared goal of meaningful delivery system reform in Texas. It authorizes Texas to establish a Delivery System Reform Incentive Payment (DSRIP) program. The PFM was finalized August 31, 2012. However, HHSC released a substantive revision to the PFM dated April 4, 2013 which was published and distributed on April 5, 2013.

The PFM delegates to the Anchoring Entity the responsibility of coordination with RHP participants in development of the RHP Plan for the region. Specifically, the anchoring entity is responsible for coordinating the development of a community needs assessment for the region, engaging stakeholders including the public, coordinating the development of the five-year RHP Plan, ensuring the plan is prepared in accordance with the standards, guidelines and checklists required by HHSC, transmitting the plan and any associated plan amendments to HHSC, coordinating the ongoing monitoring and annual reporting on the status and performance of projects, and coordinating ongoing communication with HHSC and regional plan participants.

RHP participants that are responsible for performing one or more DSRIP projects are called Performing Providers. All Performing Providers must have a current Medicaid provider identification number. Performing Providers that complete RHP project milestones and measures are eligible to receive DSRIP incentive payments.

Intergovernmental Transfer (IGT) Entities provide the non-federal share of funding for the Waiver program. IGT Entities include the anchoring entity, government-owned performing providers, community mental health centers, local health departments, academic health science centers and other governmental entities such as counties.

The PFM outlines that the DSRIP pool will be allocated to each RHP region on the basis of the region’s percent of state population with income below 200 percent of the federal poverty level, the percent of Texas Medicaid acute care payments and the percent of total Medicaid supplemental payments made to providers in the RHP. Applying this basis, the following table presents the state DSRIP pool by demonstration year (DY) and its allocation to Region 9.

FY 2012
FY 2013
FY 2014
FY 2016
$500 M
$2,300 M
$2,666 M
$2,852 M
$3,100 M
$11,418 M
RHP 9 (14% State)
$71 M
$329 M
$381 M
$407 M
$443 M
$1,631 M
Parkland (40% RHP9)
$26 M
$133 M
$154 M
$164 M
$179 M
$630 M

The PFM provides the required RHP Plan template and outlines the key elements associated with each RHP Plan. The Plan elements include a presentation of the plan organization and participants, overarching goals for the region, a summary of the environment, key challenges the region is confronting, a summary of how the DSRIP projects will realize the regional goals and an assessment of community needs.

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