Framing Elements of the Waiver

Waiver Funding Pools

Through the 1115 Healthcare Transformation Waiver, supplemental payment funding, managed care savings, and negotiated funding will go into two statewide pools worth $29 billion (all funds) over five years. Funding from the pools will be distributed to hospitals and other providers to support the following objectives:

  • Uncompensated Care (UC) Pool to reimburse for uncompensated care costs as reported in the annual Waiver application/UC cost report and designed to help offset the costs of uncompensated care provided by the hospital or other providers.

  • Delivery System Reform Incentive Payment (DSRIP) Pool to incentivize hospitals and other providers to transform their service delivery practices to improve quality, health status, patient experience, coordination and cost effectiveness.

To receive payments from the UC and/or DSRIP pools, entities must participate in a Regional Healthcare Partnership (RHP).

Regional Healthcare Partnerships (RHPs)

The Waiver sets forth the types of entities eligible to participate in RHPs to include: hospitals, community mental health centers, local health departments, physician practice plans affiliated with an academic health science center and physician practice plans not affiliated with an academic health science center. Within the partnership, participants include governmental entities providing public funds known as intergovernmental transfers (IGT), Medicaid health care providers and other stakeholders.

HHSC has defined 20 RHP regions in Texas. Each RHP has one anchoring entity which acts as the primary point of contact for HHSC in the region and is responsible to serve as an administrative extension of HHSC with respect to the regional activities.

Parkland Health & Hospital System (Parkland) is designated as the anchoring entity for Region 9 which consists of three counties — Dallas, Denton and Kaufman. The participants and stakeholders in each region are charged with developing a regional plan, identifying partners, assessing community needs, proposing projects to address the community needs and outlining the funding distribution for each pool.

Delivery System Reform Incentive Payment (DSRIP) Program

The RHP Planning Protocol (DSRIP Project Menu) presents a menu of evidence-based projects that can be incentivized through DSRIP. The projects were selected by HHSC and the Centers for Medicaid and Medicare Services (CMS) to have the maximum impact on the health system challenges facing Texas and to promote the IHI Triple Aim. It is anticipated that multiple, complementary initiatives will be occurring in the same RHP simultaneously, reinforcing each other in the transformation of care delivery.

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