1. May 10, 2012

2.  Committee charter  Understand waiver funds flow  IGT fundamentals  UC pool payments  DSRIP pool payments  Timeframes  Begin work on RHP budget 2

3. Intergovernmental Transfer (Public Funds) Uncompensated Care Pool (UC) RHP Membership Required Each Provider’s Costs * Uninsured * Medicaid Shortfall Reduced by payments Cost Based Payment Delivery System Reform Incentive Payment Pool (DSRIP) RHP Membership Required Each Provider’s Projects Chosen from Menu Performance Metrics Met Incentive Payment State/Local Funds (42%) Federal Match (58%) 3

4.  Intergovernmental Transfers ◦ Federal Government matches state/local funds spent on the Medicaid program  Approximately 42% state/local  Approximately 58% federal  Expect that FMAP rate changes over the life of the waiver  IGT providers ◦ Hospital districts ◦ Counties ◦ MHMRs ◦ Medical schools ◦ Other government? 4

5.  State/local share must be public funds ◦ Taxes ◦ Commercial insurance receipts ◦ Investment income ◦ Qualified donations ◦ Other non-Federal ◦ Other?  Cannot be receipts from delegation of a governmental duty  Spreadsheet available for use by potential IGT entities 5

6.  Eligibility for pool payments ◦ RHP membership ◦ UC application filed  Eligible entities ◦ Hospitals ◦ Physician practices ◦ Government ambulance providers ◦ Governmental dental providers ◦ Other providers in rural RHPs with no public hospital  IGT must be provided by governmental entity 6

7.  Qualified amounts – based on data from 2 years prior to payment year ◦ Costs related to providing care to persons with no third party coverage ◦ Medicaid shortfall  For services covered by Medicaid ◦ Inpatient/outpatient (DSH cap calculation) ◦ Physician and mid-level services ◦ Outpatient drugs ◦ Physician practices 7

8.  Necessary data elements ◦ Medicaid and uninsured charges by Medicare cost center ◦ Medicaid and uninsured days by Medicare cost center ◦ Medicaid cost to charge ratios ◦ Medicaid payments  DSH  FFS and managed care ◦ Patient payments ◦ Any other payment made on behalf of the patient 8

9.  UC payments classified as Medicaid payments  Total payments received for uninsured and Medicaid cannot exceed costs for providing services  Process description document at end of this document  Spreadsheets we used are available 9

10.  Payment is incentive based – unrelated to cost  Eligibility for pool payments ◦ RHP membership ◦ Participation in transformation projects  Eligible entities – any health care entity participating in DSRIP projects 10

11.  IGT must be provided by governmental entity  Performance metrics must be met in order to receive payment  Not considered a Medicaid payment 11

12.  UC Tool completion ◦ Contracted services issue ◦ Tobacco funds ◦ Adjustments to cost report numbers  Pool allocations  IGT – conversion of private funds to public funds ◦ Provider donation limitations  DSRIP project pricing 12

13.  June 15: ◦ Finalize UC and IGT numbers  June 30: ◦ Finalize DSRIP pricing strategy ◦ Plan for 2012 DSRIP  August 31: RHP plan due to HHSC  October 31: RHP plan to CMS 13

14.  Begin work on budget ◦ Identification of available IGT ◦ Put together actual UC numbers  Assist in developing pricing model for DSRIP projects  Continue to monitor and impact waiver issues with HHSC and CMS 14

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