Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 355 - REIMBURSEMENT RATES
Subchapter J - PURCHASED HEALTH SERVICES
Division 11 - TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM REIMBURSEMENT
Section 355.8204 - Funding for DSRIP Monitoring Program

Universal Citation: 1 TX Admin Code § 355.8204

Current through Reg. 49, No. 38; September 20, 2024

(a) Introduction. The Texas Healthcare Transformation and Quality Improvement Program §1115(a) Medicaid demonstration waiver provides for supplemental payments to many types of providers. In order to ensure that such payments are made properly, HHSC will contract with one or more independent entities to monitor the Delivery System Reform Incentive Payment (DSRIP) program. This section describes the method by which HHSC will gain the source of the non-federal share of payments to reimburse the independent entity for its administrative expenses. For purposes of this rule, the definitions in § RSA 354.1602 of this title (relating to Definitions) apply, except where otherwise indicated.

(b) Funding for Delivery System Reform Incentive Payment program monitoring. HHSC will allocate an intergovernmental transfer (IGT) amount to each DSRIP IGT entity to fund DSRIP monitoring activities.

(1) HHSC will determine the amount of the IGT allocation in each demonstration year for each IGT entity. The amount of the IGT allocation for each IGT entity will be calculated using the following formula: IGT Allocation = (AffiliatedValue/DYValue) x TotalIGT, where:

(A) "AffiliatedValue" is the portion of the value for which the IGT entity agreed to fund the non-federal share for all DSRIP projects that the IGT entity is affiliated with for a particular demonstration year; and

(B) "DYValue" is the value for all DSRIP projects in the state for the same demonstration year as used in subparagraph (A) of this paragraph.

(C) "TotalIGT" is the total amount of IGT necessary for monitoring activities in a demonstration year, as determined by HHSC. This amount may not be greater than $5 million.

(2) The values utilized in paragraph (1) of this subsection are the federally approved values as of January 1 of the calendar year in which the calculation occurs.

(3) The full IGT allocation for monitoring will be requested the first time an IGT entity provides an IGT for a demonstration year.

(4) No IGT may be allocated for the waiver monitoring program prior to the first DSRIP reporting opportunity for the third demonstration year.

(5) An IGT entity may choose to provide the IGT allocation from either an IGT intended to fund a DSRIP payment or in addition to an IGT submitted to fund a DSRIP payment.

(c) Return of unused intergovernmental transfers. The balance of any allocation not used to fund monitoring activities will be returned to the IGT entities. The amount returned is calculated on a pro rata basis in accordance with the amount of such entities' intergovernmental transfers intended to fund the DSRIP monitoring program for the demonstration year for which the refund is made.

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