1. RHP 14 Learning Collaborative July 18, 2014 Kevin Nolting Consulting

2. Recent Information on DY 3 UCC Funding Activities:  HHSC has developed the Texas Hospital Uncompensated Care (TXHUC) application, a combined DSH and UC application for FFY 2014 (DY 3)  This application will serve two purposes  HHSC will be using information in the application to conduct the interim reconciliation for all providers that received a FFY 2011 Demonstration Year (DY 1) UC payment as required under the CMS UC Waiver Claiming Protocol.  All providers that wish to participate in the FFY 2014 DSH and/or in the DY 3 UC program have to complete and submit the application. ◦ Providers wanting to participate in the FFY 2014 DSH program and/or the DY 3 UC program must complete the TXHUC to be eligible. ◦ Providers who received DY 1 UC payments must complete the form or will be subject to recoupment of all DY 1 UC payments ◦ HHSC deadline for requesting a copy of the TXHUC is July 23, 2014. ◦ A hospital that fails to request a TXHUC by the deadline will not be eligible to participate in the 2014 DSH and DY 3 UC programs or to appeal HHSC's non-qualification decisions. ◦ No published estimate of future program funding dates.

3. Recent Information on DY 2 UCC Funding Activities: ◦ HHSC distributed $3.9 Billion in DY 2 UCC payments (total allocation) ◦ Statewide committed IGT would have paid $4.9 Billion ◦ Resulted in a 21.7% haircut to remain within DY 2 UCC Pool allocation ◦ Total UCC costs reported was $5.9 Billion

4. The following are funding questions that need to be addressed collaboratively between HHSC and the Waiver participants: Allocation of dwindling UC Pool. Future impact on indigent care affiliations due to reduced UC Pool and future “haircuts”. Impact of the outcome of HHSC Rider 86. Impact of future changes related to the Affordable Care Act. Status of DSH funding for future years. Prepare for negotiations on Waiver renewal and strategies for successful outcomes.

5. Current Waiver Pool Allocations Type of Pool DY 1 (2011- 2012) DY 2 (2012- 2013) DY 3 (2013- 2014) DY 4 (2014- 2015) DY 5 (2015- 2016) Totals UC3,700,000,0003,900,000,0003,534,000,0003,348,000,0003,100,000,000$17,582,000,000 DSRIP500,000,0002,300,000,0002,666,000,0002,852,000,0003,100,000,000$11,418,000,000 TOTAL/DY4,200,000,0006,200,000,000 $29,000,000,000 % UC88%63%57%54%50%60% % DSRIP12%37%43%46%50%40% UPL Est. (Inflated 3% per year) 2,873,236,484 2,959,433,578 3,048,216,585 3,139,663,083 3,233,852,976$15,254,402,706

6. UPL Program FY 2011 DY 1 (2011- 2012) DY 2 (2012- 2013) DY 3 (2013- 2014) DY 4 (2014- 2015) DY 5 (2015- 2016) Totals (DY 1- DY5) Private1,488,282,533 1,532,931,009 1,578,918,939 1,626,286,508 1,675,075,103 1,725,327,3568,138,538,915 Large Urban1,021,243,839 1,051,881,154 1,083,437,588 1,115,940,716 1,149,418,937 1,183,901,5065,584,579,901 State 93,165,689 95,960,659 98,839,479 101,804,664 104,858,804 108,004,568 509,468,174 Rural 81,135,922 83,569,999 86,077,099 88,659,412 91,319,195 94,058,770 443,684,475 Children’s 34,899,942 35,946,940 37,025,348 38,136,109 39,280,192 40,458,598 190,847,186 Physician’s 70,822,060 72,946,722 75,135,124 77,389,178 79,710,853 82,102,179 387,284,056 Total2,789,549,984 2,873,236,484 2,959,433,578 3,048,216,585 3,139,663,083 3,233,852,97615,254,402,706 Historical UPL Expenditures Projected

7. Scenarios on Impacts on IGT resulting from a Haircut Description Scenario A (No Haircut) Public Scenario A (No Haircut) Private Scenario B (20% Haircut) Public Scenario B (20% Haircut) Private Scenario C (40% Haircut) Public Scenario C (40% Haircut) Private UC Payment/IGT Calculation: UC Cap 16,000,000 Haircut (Scenario B - 20%) N/A 20% 40% Revised UC Cap Eligible for IGT 16,000,000 12,800,000 9,600,000 Indigent Care/Expense Alleviation10,000,000(10,000,000)10,000,000(10,000,000)6,000,000(6,000,000) UC Payment to Private Hospital 15,000,000 12,800,000 8,750,000 IGT from Public to Private for UC(6,000,000) (5,100,000) (3,500,000) Amount for Additional Services/UC4,000,0005,000,0004,900,0002,800,0002,500,0002,750,000

8. Kevin Nolting knolting@noltingconsulting.com