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About 1115 Waiver  

The Texas Healthcare Transformation and Quality Improvement Program (the 1115 Waiver) allows the state to expand Medicaid managed care while preserving federal hospital funding historically received as Upper Payment Limit (UPL) payments—supplemental payments to make up the difference between what Medicaid pays for a service and what Medicare would pay for the same service. Replacing the UPL payment methodology are two funding pools – the Uncompensated Care and Delivery System Reform Incentive Payment (DSRIP) pools.

Uncompensated Care Pool Payments are designed to help offset the costs of uncompensated care provided by the hospital or other providers.

DSRIP Pool Payments are incentive payments to hospitals and other providers that develop programs or strategies to enhance access to health care, increase the quality of care, the cost-effectiveness of care provided and the health of the patients and families served.

Under the transformation waiver, eligibility to get Uncompensated Care or DSRIP payments will require participation in a regional healthcare partnership. Within a partnership, participants include governmental entities providing public funds known as intergovernmental transfers (IGT), Medicaid providers and other stakeholders. Participants will develop a regional plan identifying partners, community needs, the proposed projects, and funding distribution. Each partnership must have one anchoring entity, which acts as a primary point of contact for HHSC in the region and is responsible for seeking regional stakeholder engagement and coordinating development of a regional plan.


For more information visit: http://www.hhsc.state.tx.us/1115-waiver.shtml  


 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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