This page gives you access to the latest information regarding the Medicaid 1115 Waiver. As information becomes available, TAC will continue to update this page with articles, documents and news.
HHSC has updated the 1115 Transformation Waiver with several additional resources:
Additional 1115 Waiver resources:
The Health and Human Services Commission has released several additional resources for the 1115 Medicaid Waiver process:
National Quality Measures Clearinghouse (NQMC) includes links to the HHS Measures Inventory (a repository of measures currently being used by the U.S. Department of Health and Human Services) and a database of National Quality Forum (NQF) Endorsed Measures.
Important update about Regional Healthcare Partnership Plan (RHP) submission timeline: HHSC has worked with the Centers for Medicare and Medicaid Services to grant more flexibility in the timeline for RHP Plan submission. On Oct. 31, RHPs will be required to submit a subset of the RHP Plan Template, which includes Section I through Section III (Community Needs Assessment). A message sent to stakeholders (PDF)
explains the timeline changes.
New Resources Available: The following resources have been added to the Tools and Guidelines for Regional Healthcare Partnership Participants page
: RHP Plan Template Companion Document (PDF)
: The companion document (updated 10/5/2012) will help RHPs use the plan template to develop their RHP plan.RHP Plan Anchor Checklist (DOC)
: The checklist (posted 10/5/2012) must be completed for and included in both Phase I (Pass 1 DSRIP) and Phase II (Full RHP Plan) RHP Plan submission packets. Other Pass 1 workbooks for performing providers (ZIP, 18MB)
: (posted 10/5/2012) for performing providers that did not receive a Pass 1 allocation but are participating in Pass 1 through collaboration. List of Affiliation Numbers (XLS)
: This document (posted 10/3/2012) provides affiliation numbers for Waiver participants for inclusion in the electronic workbook.
Final Regional Healthcare Partnership map and contact information for the anchors.
RHP 1 - The University of Texas Health Science Center at Tyler (UTHSCT)
RHP 2 - University of Texas Medical Branch
RHP 3 - Harris County Hospital District
RHP 4 - Nueces County Hospital District
RHP 5 - Hidalgo County
RHP 6 - University Health System
RHP 7 - Travis County Healthcare District (dba Central Health)
RHP 8 - Texas A&M Health Science Center
RHP 9 - Dallas County Hospital District (dba Parkland Health and Hospital)
RHP 10 - Tarrant County Hospital District (dba JPS Health Network)
RHP 11 - Palo Pinto General Hospital District
RHP 12 - Lubbock County Hospital District - University Medical Center
RHP 13 - McCulloch County Hospital District
RHP 14 - Ector County Hospital District (dba Medical Center Health System)
RHP 15 - University Medical Center of El Paso (El Paso Hospital District)
RHP 16 - Coryell County Memorial Hospital Authority
RHP 17- Texas A&M Health Science Center
RHP 18 - Collin County
RHP 19 - Electra Hospital District (dba Electra Memorial Hospital)
RHP 20 - Webb County
In developing the RHP Regional Map
and anchor list
, HHSC worked with the regions in contention and held a public hearing on May 17, 2012. Please note that to reflect patient flow, an IGT entity may fund a performing provider in a contiguous RHP based on certain principles. For instance, total computable payment must stay with the recipient, and the project must be included in the performing provider’s RHP plan.
In order to meet the September 1, 2012, RHP plan submission deadline, HHSC encourages all RHPs to begin or continue developing plans—including assessing community needs, reviewing the draft Delivery System Reform Incentive Payment (DSRIP) project menu
and draft Program Funding and Mechanics (PFM) Protocol
, and estimating possible funding levels. In June and July, HHSC plans to negotiate with our federal partner, the Centers for Medicare and Medicaid Services, detailed waiver requirements including both the DSRIP menu and PFM Protocol. Because CMS approval of RHP plans is contingent on these protocols, HHSC will continue to update stakeholders on a regular basis regarding the CMS negotiations.
HHSC recognizes the timeline for implementing the 1115 Transformation waiver is very tight and very much appreciates your patience in this new process. For updated materials and to sign up for email alerts, please refer to the waiver website
. Should you have any questions, please email ..
RHP Planning Summit to be held in August: In order to better utilize attendees’ time at the RHP Planning Summit, HHSC has postponed the conference until early August rather than holding it in late June as originally planned. At the summit, HHSC will provide technical assistance to directly help those RHP participants developing a regional plan. In June and July, HHSC plans to negotiate with our federal partner, the Centers for Medicare and Medicaid Services, detailed waiver requirements including the DSRIP menu and Program and Funding and Mechanics Protocol. By postponing the summit, HHSC hopes to provide more complete information to RHPs to enable them to develop and submit their plans. Prior to the summit, HHSC will continue to update stakeholders on a regular basis regarding the CMS negotiations.
Summit Registration: HHSC is working to finalize the details—including dates, times, and location—of the RHP Planning Summit. Once those details are confirmed, registration will open for a limited number of individuals. Because space at the conference will be limited, HHSC will send invitations in waves and those receiving an invitation will have up to one week to accept before additional invitations will be sent. Each Regional Healthcare Partnership (RHP) will have a certain number of in-person slots for the summit, so that the anchor along with key IGT entities and performing providers will be able to attend to receive information about how to complete and submit the RHP plan. HHSC will broadcast the conference online so that individuals not able to attend in-person can watch presentations, hear discussions, and submit questions through an online chat function.
Action Required - UPDATED ANCHOR LIST & RHP MAP
The Texas Health and Human Services Commission has released an updated anchor list
and Regional Healthcare Partnership Map
, dated May 11, 2012 - both of which are based on RHP confirmation forms submitted to HHSC in April. According to a HHSC release, the commission attempted to incorporate all submitted requests into the new map but could not in all cases due to geographic proximity and conflicting submissions. In updating the map, HHSC considered the RHP principles
(dated April 2, 2012). HHSC only included requests submitted in an iRHP Confirmation Form via the waiver email address or fax by April 24, 2012.
Final Chance to Comment: Please review the map and confirm your county’s region. If you are not in a region that you prefer or if the choice of anchor is still in dispute, then you should plan to request changes via in-person testimony at the May 17, 2012 public hearing.
If you are interested in listening in on the hearing, a conference call line is available for out-of-town stakeholders. Please note: stakeholders wishing to testify need to attend the hearing in person. Testimony will not be allowed over the conference call line.
Conference Call Number – 1-877-226-9790 Access Code – 8317345
May 17, 2012 - RJP Public Hearing
as published in the May 11, 2012 Texas register
May 17, 2012 - RHP agenda
Please note: the public hearing will discuss the May 11, 2012 map, not the March 30, 2012 map.
**A few important items not included in the attached notices that HHSC would like to share with stakeholders include:
The public hearing will start promptly at 1:30 p.m. HHSC will hear public testimony until each person who wishes to speak has an opportunity to present. If testimony ends before 4:30 p.m., the hearing will end early. Those interested in speaking at the public hearing should plan to arrive by 1:30.
The purpose of the hearing is for Executive Commissioner Tom Suehs to hear from entities in RHPs that are still in contention (either counties disagreeing with RHP placement on the May 11, 2012 map or an RHP anchor still in question) in order to finalize RHP region development. HHSC requests those counties and anchors in question to please attend the public hearing to voice concerns to the Executive Commissioner. The Executive Commissioner will take these public hearing comments into consideration when developing the final RHP geography and anchors. HHSC will issue the final RHP map shortly following the public hearing based on the Executive Commissioner’s final recommendations and submit to CMS for federal approval.
HHSC encourages RHP participants to work together prior to the public hearing to determine RHP geography and anchors.
During the public hearing, HHSC intends to accept comments in response to the May 11, 2012 RHP map, not the March 30, 2012 RHP map.|
Depending on the amount of public comment during the hearing, the 3-minute presentation rule may be invoked.
HHSC continues to work with CMS to determine how an IGT entity can fund a performing provider in a different RHP based on certain principles. For instance, total computable payment must stay with the recipient. HHSC recognizes that IGT crossing regions is particularly important for specialty providers—such as children’s hospitals or burn care—that may serve more than one RHP.
TAC will continue to provide information as it becomes available. For questions, please contact , (800) 456-5974.
1115 Waiver Rules Open for Public Comment
The Health and Human services Commission (HHSC) published proposed waiver reimbursement rules for hospitals and physician services on the Texas Register website. The rules were published in the April 20, 2012 edition of the Texas Register, which triggers the 30-day comment period.
These rules provide detailed direction for waiver program participation including information regarding county requirements. Waiver Payments to Hospitals (#2 below) gives more direction for county involvement.
TAC §355.8066 (Hospital Specific Limit Methodology) may be viewed here
. The hospital specific limit methodology is used in the calculation of a hospital’s uncompensated-care waiver payments and disproportionate-share hospital program payments.
TAC §355.8201 (Waiver Payments to Hospitals) may be viewed here
TAC §355.8202 (Waiver Payments for Physician Services) may be viewed here
If you are interested in providing comments on the proposed waiver reimbursement rules, you may do so either at the public hearing or by submitting them to HHSC as explained below. Should you county provide comments; please copy .Public Hearing
The Medical Care Advisory Committee (MCAC) meeting on May 10, 2012, will function as a public hearing to receive public comment on these proposed rules. The MCAC meeting will be held in the John H. Winters Public Hearing Room at 701 West 51st Street, Austin, Texas. Entry is through security at the main entrance of the building, which faces 51st Street. Persons requiring American with Disabilities Act (ADA) accommodation or auxiliary aids or services should contact Carol Chavez by calling (512) 491-1763 at least 72 hours prior to the meeting to make appropriate arrangements.Public Comment
Written comments on the proposal may be submitted to Jill Seime, Hospital Rate Analysis Department, Texas Health
and Human Services Commission, Mail Code H-400, P.O. Box 85200, Austin, TX 78708-5200, by fax to (512) 491-1436, or by e-mail to within 30 days of publication of this proposal in the Texas Register.
The proposed waiver reimbursement rules for hospitals and physician services are now available for viewing on the Texas Register website. The rules will be published in the April 20, 2012 edition of the Texas Register, which triggers the 30-day comment period.
1) Proposed RHP Map
– This updated map (dated March 31, 2012) of the proposed RHPs by geographic area is based on hundreds of responses to the HHSC preliminary map. Further details concerning how HHSC developed this map are included under “RHP Principles.” Please review the map and confirm you are in the region your county prefers. If you are not satisfied, please see #4 RHP Confirmation Form
2) RHP Principles
– This document includes an overview of HHSC’s approach to updating proposed RHPs based on stakeholder feedback, as well as next steps and general RHP development guidelines. The intent of these guidelines is to define an RHP, outline terms of RHP participation, and clarify the anchor role. TAC and the County Judges and Commissioners Association are working to get more direction from HHSC on specific county-related projects. If you have questions about whether prospective projects will qualify for Intergovenmental Transfers (IGT), send your specific examples to and we will submit them to HHSC.
– RHP participants can use this list of preliminary anchors by RHP region to assist with regional planning. HHSC included on this list all proposed RHP anchor entities submitted in response to the February 2012 RHP map survey except for entities that HHSC determined cannot be anchors. This list only includes those entities who have expressed interest in serving as an anchor from the RHP Preliminary Survey therefore additional anchoring entities are not listed. Please review the list of prospective anchors and if your region has multiple candidates, consider supporting your preferred anchor and file letters or resolutions with HHSC before the April 24 deadline.
4) RHP Confirmation Form
- Each RHP anchor must complete this form and submit it to HHSC by April 24, 2012, to determine the geographical boundaries of the RHP. The form may be used to either confirm or suggest changes to HHSC’s proposed RHP map. HHSC will only accept one form from: (1) each anchoring entity, and (2) for those with conflicts in RHP placement, a county. Further instruction is included in the attachment. If your county is not satisfied with the Proposed RHP Map, it has been suggested when sending this form to HHSC, your county should copy your members of the legislature.
5) April Outreach Plan
– This outreach plan is a schedule of 21 webinars / conference calls throughout April 2012 intended to help participants finalize RHP regions by May 1. An April 9, 2012, kick-off webinar / call will go over each of the tools provided in this email. On April 10, 2012, HHSC will review a draft of the Delivery System Reform Improvement Plan (DSRIP) menu. From April 13 to April 20, 2012, HHSC will hold a webinar / conference call with each of the proposed RHP regions to discuss the updated map and any regional concerns in RHP development. Please note the first webinar is Monday, April 9, 2012, 3-4:30pm – 1115 Transformation Waiver Update: Overview of RHP Development.
6) by April 23, 2012. HHSC will soon post on the website instructions how to submit comments on this draft menu. On April 10, 2012, HHSC will review a draft of the DSRIP menu. If submitting comments on this draft menu by April 23, 2012, please copy .
7) DSRIP menu overview
– This is a supplemental guide to the Draft DSRIP menu provided above. On April 10, 2012, HHSC will review a draft of the DSRIP menu. 1115 Waiver Newsletter Articles
This series of articles will provide an overview of the progress made regarding the waiver, including waiver background and legislative hearings.
March 19 - HHSC Working to Establish Guidelines for 1115 Medicaid Waiver
Jan. 20 - HHSC Offers Detail About Changes, Access to UPL Funding
Dec. 15 - CMS Approves Waiver Allowing Texas to Expand Managed Care
Sept. 29 - County Affairs Holds Hearing on Health Care Reform
WebinarCounty Officials Invited to Medicatd Waiver Webinar, Live Meetings
Presentation of Texas Health Care Transformation 1115 waiver
View a draft template
from HHSC on the Regional Healthcare Plan. Please discuss the plan with your local healthcare providers and provide feedback if items need additional clarification, reorganization, or removal.Questions & Answers
List of questions and answers regarding the waiver including Regional Health Partnerships guidelines.Frequently Asked Questions
A PowerPoint presentation given by Maureen Milligan, Deputy Director for Quality and Cost Containment for Medicaid/CHIP. The presentation gives an overview of the recently approved 1115 Medicaid Waiver and how it could impact counties. This was presented to commissioners court members at the V.G. Young Institute School for County Commissioners Courts on February 8, 2012.Maureen Milligan PresentationRoles & Responsibilities
HHSC document that gives details to a Regional Healthcare Partnership including roles and responsibilities of participants and principles.Regional Healthcare Partnerships Roles & Responsibilities
A detailed approval letter to HHSC illustrating expectations, performance measures and procedures for the 1115 Waiver process.Federal approval letter and documents
Proposed Regional Health Partnership Map
The federal waiver must include all areas of the state, therefore all counties who do not choose to participate within a contiguous RHP region will be assigned to one. If assigned to a region, your county is not obligated to participate in the waiver program or commit any local property tax dollars.Map distributed by HHSC as a suggestion for regions
Preliminary RHP Regions Survey
If your county has any interest in the program, please complete the survey from the Texas Health and Human Services Commission on the new 1115 Medicaid Waiver Program.
For more information visit the Health and Human Services Commission 1115 Waiver home page