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 355.8218 - Funding for DSRIP Monitoring Program for Demonstration Years 9-10

Universal Citation: 1 TX Admin Code ยง 355.8218

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 Delivery System Reform Incentive Payment (DSRIP) program payments to eligible performers. In order to ensure that such payments are made properly, the Health and Human Services Commission (HHSC) will contract with one or more independent entities to monitor the 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 section, the definitions in § 354.1729 of this title (relating to Definitions) apply, except where otherwise indicated.

(b) Funding for DSRIP 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 (DY) for each IGT entity. The amount of the IGT allocation for each IGT entity will be calculated using the following formula: IGT Allocation = (AffiliatedValue divided by DYValue) multiplied by 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 performers that the IGT entity is affiliated with for a particular DY;

(B) "DYValue" is the value for all DSRIP performers in the state for the same DY as used in subparagraph (A) of this paragraph; and

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

(2) The values utilized in paragraph (1) of this subsection are the official 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 DY.

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

(c) Return of unused IGTs. 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' IGTs intended to fund the DSRIP monitoring program for the DY for which the refund is made.

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