In December 2011, the Texas Health and Human
Services Commission (HHSC) received approval for a waiver of certain
federal Medicaid requirements under Section 1115 of the Social
Security Act. The Texas 1115 Waiver is a five-year demonstration
The Texas Healthcare Transformation
and Quality Improvement Program (the Transformation Waiver)
allows the state of Texas to expand Medicaid managed care while
preserving federal hospital funding historically received as
Upper Payment Limit (UPL) payments — supplemental
payments to make up the difference between what Medicaid pays
for a service and what Medicare would pay for the same service.
Replacing the UPL payment methodology are two funding pools — the
Uncompensated Care (UC) Pool and the Delivery System Reform Incentive
Payment (DSRIP) Pool.
- Uncompensated Care Pool payments are designed
to help offset the costs of uncompensated care provided by the
hospital or other health care providers.
- DSRIP Pool Payments are incentive payments
to hospitals and other health care providers that developed
programs or strategies to enhance access to health care, increase
the quality of care, improve the cost-effectiveness of care
and benefit the health of the patients and families served.
HHSC has defined the types of entities eligible
to participate in the Transformation Waiver 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. To receive payments from the UC and/or DSRIP
pools, entities must participate in a regional health care partnership.
Within the partnership, participants include governmental entities
providing public funds known as intergovernmental transfers
(IGT), Medicaid health care providers and other stakeholders.
has defined 20 regions in Texas that define the geographic boundaries
of regional health care partnerships. Region Nine consists of
three counties — Dallas, Denton and Kaufman. The participants
in each region are charged with developing a regional plan identifying
partners, community needs, proposed projects to address the community
needs and the funding distribution for each pool. Each partnership
has one anchoring entity which acts as the primary point of contact
for HHSC in the region and responsible to serve as an administrative
extension of HHSC with respect to the regional activities. In
Region Nine, Parkland Health & Hospital System has been
designated as the anchoring entity.
For more information regarding
the program, please follow the links below or visit the HHSC
of the Waiver
Delivery System Reform
Incentive Payment (DSRIP) Program
DSRIP Funding and Mechanics
Regional Healthcare Partnership
9 (RHP 9)