Provide updates from HHSC on DY1 Payments and CMS plan review Review DY2 project activities, reporting and payments Discuss DY3 Planning Provide updated lead representative/contact changes Discuss Anchor Team restructure Q&A Next Steps/Estimated Timeline

RHP 17 Payments First plan submitted to CMS DY1 IGT Transfers Entered by March 7, 2013 DY1 IGT Transfers Processed (Settled) on March 8, 2013 DY1 Payments to Providers on March 28, 2013 TEXNET Reminders – IGT Transfers Use Identification Code for waiver activity transfers Transfers MUST BE completed by 6 p.m. the business day prior to IGT Settlement Date (by 6 p.m. March 7 th for DY1) Enter the IGT transfer for each Performing Provider being supported as a separate transaction Submit with Trace # (or screen shot) to HHSC

HHSC DY1 Payment Schedule Three DY1 DSRIP Payment Cycles 1 st – RHPs 14 & 17 (IGT March 7 th ; Payment March 28 th ) 2 nd – RHP 8 & 7 others (IGT March 22 nd ; Payment April 30 th ) 3 rd – Remaining 10 RHPs (IGT April 24 th ; Payment May 15 th ) DY1 IGT and Payment Notification HHSC sent out March 4, 2013 with spreadsheet for confirmation of IGT entity, IGT commitment due, and estimated DSRIP payment for each Performing Provider Anchor Team working with HHSC to update distribution list for DSRIP Anchor Team working with HHSC to update any missing/incorrect information

One Remaining DY1 UC Payment IGT due between March 27 th - April 12 th Payment made on March 5 th Have submitted questions related to this DY1 UC Payment; awaiting response from HHSC IGT entities and Providers should be notified approximately one week before the IGT commitment is due Payment to providers should occur approximately three weeks following IGT transfer

November 16, 2012 – RHP 17 Plan submitted to HHSC 31 Category 1 & 2 projects; 34 Category 3 projects; 6 Category 4 projects Total DSRIP project value - $77,775,373 Total UC funds - $184,500,000 December 21, 2012 – HHSC provided technical feedback January 25, 2013 – Revised RHP 17 Plan submitted to HHSC February 15, 2013 – HHSC submitted RHP 17 Plan to CMS

RHP 17 Plan submitted to CMS on February 15, 2013 Categories 1-3 – Nine projects (of 65) projects identified for minor technical correction Category 4 – One narrative (of six) flagged; may require additional comment by provider Valuation – Three projects (of seven) remained flagged by HHSC CMS Preliminary Feedback Received February 22, 2013 High-level project summary review identified two projects unlikely to be approved Replacement projects will total same value, so RHP and provider funding should not be negatively affected

Elective Revisions to Existing Projects Elective revisions to existing projects should NOT be submitted while CMS plan approval pending Considered project modifications & must follow outlined PFM process Formal Review Timeline CMS has 45 days to review/return comment (April 4, 2013) CMS will approve project-by-project and not just blanket plan approval Projects not approved at 45-day review will require revision RHP 17 has 30 days to provide a response (May 5, 2013) Replacement projects should be submitted prior to April 4 th (require HHSC approval before CMS review and new 45-day timeline begin)

DY2 Project Implementation Providers may begin DY2 project activities at their own discretion. Providers may begin to implement DY2 activities prior to plan approval by CMS. Regardless of how long formal plan approval takes, DY2 payments are solely tied to 100% completion of metrics.

Reporting Periods Reporting Period 1 – June or August 2013 Requires regional consensus of providers Reporting Period 2 – October 2013 Reporting Mechanism & Process Manual mechanism for DY2 (Excel spreadsheet) Working with vendor on format Most likely distributed through anchor

Review & Approval Process HHSC and CMS will concurrently review report over 30 days If report is not approved during the initial 30-day review, providers will have 15 days to revise and submit reports/additional documentation HHSC and CMS will have an additional 15 days to review and approved revised reports Payments Approved report (documenting metrics met 100%) triggers payment If the report is not approved during the initial 30-day review, the payment will be pushed to the next reporting period

HHSC Estimated Payment Dates for DY2 DSRIP HHSC will notify IGT entities and Performing Providers via 7 days prior to required IGT transfer will contain spreadsheet outlining IGT entity, IGT commitment due and estimated DSRIP for each performing provider Payment should be made to provider approximately 3 weeks after IGT transfer DY2 DSRIP Payment TypeIGT DuePayment Date 1A (of 2) – Rpt 1 June9/9/20139/30/2013 1B (of 2) – Rpt 1 Aug.10/21/201311/12/ (of 2) – Rpt 2 Oct.1/3/20141/24/2014

HHSC Estimated Payment Dates for DY2 Uncompensated Car e HHSC will notify IGT entities and providers via 7 days prior to requested IGT transfer will include max amount that can be IGTd along with UC caps may include a UC worksheet to help direct payment Payment to providers should occur three weeks following IGT transfer DY2 UC Payment TypeIGT DuePayment Date Q1-Q2 (proxy)6/10 – 6/28/20137/20/2013 Quarter 311/22 – 12/13/20131/16/2014 Quarter 42/26 – 3/10/20143/28/2014

HHSC maintains a distribution list of vendors paid under UPL and Transitional Waiver that is now the UC distribution list Anchor Team working with HHSC to get new and appropriate RHP 17 IGT Entities and Providers added Several Amendments to UC Rules proposed/adopted Additional questions related to UC process and payments submitted to HHSC; awaiting response

Per HHSC, DY3 planning process and requirements are still being determined Regional DSRIP allocations should be equal to the remainder of unused funding Anticipate planning will begin in late May/early June with completion by early September

Request for modifications to existing projects (project scope, milestones, metrics, targets, etc.) require good cause – written request with justification Modifications require HHSC and CMS review/approval Modification requests must be submitted within 90 days following the end of the Demonstration Year Modification requests/assistance for RHP 17 will begin October 1, 2013 and should be completed by December 10, 2013 for submission to/review by HHSC prior to the holiday season

Section I of the RHP 17 Plan has been revised to reflect the following: Huntsville Memorial Hospital Sally Nelson retired and Mr. Shannon Brown is the new CEO Shannon L. Brown Chief Executive Officer 110 Memorial Hospital Drive Huntsville, TX Tri-County Services MHMR Cindy Sill retired and Mr. Evan Roberson is the new Executive Director Evan Roberson Executive Director PO Box 3067 Conroe, TX

Texas A&M Health Science Center assigned to provide Medicaid activity evaluation for the State Requires fire-walling of the various Anchor Team, Performing Provider, and Evaluation Team activities Dr. Monica Wendel assigned to the Evaluation Team Dr. Lee Ann Ray is now the Co-Director of TAMHSC Rural Community Health Institute which oversees all 1115 TAMHSC Waiver Activities Ms. Angie Alaniz is now the Director, TAMHSC Anchor Teams Ms. Shayna Spurlin is now the RHP 17 Project Director Project Coordinator (TBD)

Open Q&A Follow-up questions can be ed to Anchor for submission to HHSC or ed directly to the HHSC with copy to Anchor Team For DSRIP and general 1115 project/report/planning questions, the Waiver inbox at: For Uncompensated Care questions, the UC Tools inbox at:

ACTIVITYDUE DATE IGT Transfers into TexNet for DY1 DSRIP PaymentsMarch 6 th by 6 p.m. Replacement Projects for CMS ReviewMarch 15, 2013 RHP 17 Receives formal feedback from CMS April 4, 2013 RHP 17 Revisions/Response to CMS FeedbackMay 2, 2013 RHP 17 DY2 Report 1June/August 2013 RHP 17 DY3 Planning/ProjectsJune-September 2013 RHP 17 Plan Modification Process opensOctober 1, 2013 RHP 17 DY2 Report 2October 31, 2013 RHP 17 Plan Modifications w/Justification to AnchorDecember 10, 2013