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HHSC Offers Detail About Changes, Access to UPL Funding

By Rick Thompson
TAC Legislative Staff

The Texas Health and Human Services Commission (HHSC) issued a letter providing more details about changes to federal funding programs and how to access Upper Payment Level (UPL) funds.

As was previously reported, the Centers for Medicare and Medicaid Services (CMS) approved a Section 1115 Demonstration Waiver on Dec. 12, 2011 to expand managed care statewide in an effort to achieve state budget savings and preserve hospital access to funding consistent with UPL.

The Jan. 5 letter was sent to Medicaid hospitals, County Indigent Care Health Program coordinators and other qualifying entities.

“This letter provides background information on who will be affected, an overview of the types of changes, and ways for you to obtain additional information on the changes and what you will need to do if you are currently involved in the UPL program, or if you would like to participate in the opportunities offered under the 1115 waiver program that will replace the current UPL program,” wrote HHSC Executive Director Thomas Suehs.

Under the waiver program, eligibility to continue receiving UPL and incentive payments (defined under “Waiver Funding” on page two of the letter) will require participation in a Regional Healthcare Partnership (RHP).

Questions remain about how the RHP will be designed, what type of participation counties will have in the RHP, what local funds will qualify for matching, how those local health care dollars may be used as matching funds to draw down additional federal dollars and what regions counties can participate in.

Since being contacted by HHSC last July, TAC and the County Judges and Commissioners Association of Texas have been working with HHSC on the development and implementation of the Medicaid Waiver. The primary goal of TAC’s participation is to represent the interest of counties and to ensure the waiver is beneficial to counties by maintaining flexibility.

Answers to additional questions are needed to get counties to utilize the waiver and participate in a RHP. TAC is continuing to work with HHSC to get those questions resolved.