1. RHP 12 Learning Collaborative

2.  DSRIP Road Trip  Survey regarding Cohort Topics  Project Highlight  Waiver Updates ◦ CAT 3 ◦ Plan Modifications and Technical Changes

3.  Two Fold-Regional and Individual ◦ Network and Learn from DSRIP projects in action ◦ Individual Project Focus  Opportunities ◦ Waiver 101 ◦ Learn/Share hands on with regional partners ◦ Hands on technical assistance for bi-annual reporting ◦ PDCA for identified projects ◦ Data Collection  When ◦ Sign up  Individual  DSRIP project in action  Host Reporting TA session

4.  September 19 th ◦ Texas Panhandle Centers-PDCA ◦ Northwest Texas Hospitals- Waiver 101  November 21 st ◦ Central Plains Center - Waiver 101

5.  Access to care  Preventive Services  Medical Home  Readmissions  Unnecessary ED Utilization  Infectious Disease Management  Post-Acute Care  Behavioral Health of Life Surveys  Survey responses requested to gauge regional interest

6. Answer Choices – Responses – –  Access to care13.33% 2 –  Preventive Services26.67% 4 –  Medical Home13.33% 2 –  Re-admissions6.67% 1 –  Unnecessary ED Utilization13.33% 2 –  Infectious Disease Management6.67% 1 –  Post-Acute Care6.67% 1 –  Behavioral Health-Quality of Life Type Surveys 13.33% 2 Total15

7.  Interventions ◦ Telemedicine Program - designed to increase mental health services that will yield more optimal and cost effective outcomes for all patients. ◦ Diabetic Self Management Program – Offers a new healthy lifestyle and wellness program with various coaching techniques for diabetic patients. New follow- up process with an ultimate goal of reducing preventable readmissions of diabetic patients  Tell us about your project  Share a patient story  Share successes  Share challenges

8. Bobbye Hrncirik

9.  DY4 measurement period will be the first 12 months immediately following the baseline period  DY5 measurement period will be the second 12 months immediately following the baseline period  Example: ◦ Baseline Period – Jan-Jun 2013 ◦ DY4 Measurement Period = July 2013-June 2014 (If data was available you might already know that you achieved your DY4 outcome targets) ◦ DY5 Measurement Period = July 2014-June 2015

10.  HHSC feedback for RHP 12 Summary: Type of RequestDisposition Plan Modification74 Approved42 Approved with HHSC changes20 Needs More Information12 Technical Change29 Approved26 Needs More Information2 Partially Approved1 Grand Total103

11.  NMI – HHSC has requested additional information on 14 plan mods/tech changes in Region 12  5 providers will need to provide additional information: ◦ Golden Plains ◦ Lynn County HD ◦ StarCare Specialty Health System ◦ University Medical Center ◦ West Texas Centers

12.  Responses are due to HHSC from the anchors on Tuesday, December 9 th  We are asking you to have your changes to us by Friday, December 5 th.  Kevin & Debra will be in touch with each provider requiring NMI for further guidance

13.  HHSC and CMS have 30 days (until December 5) to review the information submitted by providers.  HHSC’s preliminary comments and signoff of “approved” or “needs more information” will be available in the DSRIP online system  Due to the volume of projects and metrics, 30 day turnaround, HHSC and CMS have agreed to a new approach for managing the volume of reports. ◦ Subset of projects reviewed in 30 days ◦ “Provisionally Approved” for projects not reviewed ◦ Full payment in January for “Provisionally Approved” ◦ Potential Recoup if not approved by April ◦ Future payment withold

14. What went well:  Online reporting system (simple)  Instantaneous review by anchor What needs to be improved:  Ability to remove files post upload  Specific buttons for uploads (i.e, QPI and Category 3 baseline templates)  Remove submit button  User friendly Summary/Coversheet on what has been reported built into reporting system

15.  Objective: Review the degree to which the project being implemented is related to the approved plan and is measureable. Identify risk issues associated with variances from the approved plan  34 projects from 21 providers within RHP 12 were selected for review  All 21 providers selected for mid-point assessment should have received an email from HHSC with several attachments including a letter explaining which projects were selected and the description of the review. Please let us know if you did not receive an email from HHSC.  NO NEWS IS GOOD NEWS

16.  HHSC will need to submit a revised waiver amendment request to ask to use these funds  CMS has indicated that the waiver amendment would not be considered while the UC Deferral is under review.  Framework – DSRIP projects that appear to be on track may add certain defined metrics in in DY5 in order to earn additional DSRIP funds: ◦ (1) Serve additional Medicaid/Low-Income Uninsured (MLIU) individuals – demonstrated by adding a MLIU specific QPI metric in DY5 if there isn’t already one or increasing the existing MLIU metric; ◦ (2) Increase data exchange to support the project (see below); and/or ◦ (3) Evaluate the success of the project (see below).

17.  The public notice states that HHSC may prioritize the DY2 funds for projects related to primary and preventive care, BH care, and chronic care management, and in particular may prioritize the funding for 58 DSRIP providers (6 RHP 12 providers) The 6 RHP 12 providers are: ◦ (1) Texas Tech Amarillo ◦ (2) StarCare Specialty Health System ◦ (3) Helen Farabee Center ◦ (4) Central Plains Center ◦ (5) Texas Panhandle Centers ◦ (6) West Texas Centers  At this stage, HHSC is requesting information for all projects other those in 1.10, 2.4, 2.5 and 2.8 regarding interest in adding on to projects to earn a portion of the remaining DY2 funds.  RHP 12 Google Document Responses due today ◦ https://docs.google.com/spreadsheets/d/1qmNLLxPD2qgajfvRXTJWRnBhgsdns7OK9 kKbrJCpCZM/edit?usp=sharing https://docs.google.com/spreadsheets/d/1qmNLLxPD2qgajfvRXTJWRnBhgsdns7OK9 kKbrJCpCZM/edit?usp=sharing

18.  HHSC sent out the DSRIP Waiver renewal survey  It is fine for multiple people within an organization to complete surveys, or for an organization to submit a more coordinated response (preferred, but not required).  The survey will close November 26, 2014. http://goo.gl/forms/vDC0RuuY5e. http://goo.gl/forms/vDC0RuuY5e  HHSC is also organizing a "Clinical Champions" work group for coordination on waiver renewal activities to focus on review of promising practices

19.  A meeting occurred this week with Cindy Mann and other senior level staff at CMS. HHSC impressed on CMS how critical this issue is to the Texas safety net and the need for speedy resolution with upcoming DSRIP payments. HHSC sent CMS a letter in advance of the meeting and also left CMS with a good deal of information that shows the history of the program including private hospital UPL state plan approval correspondence, 2007- 2008 deferral correspondence, the certifications, etc. CMS said they would review this additional information.  HHSC is working to submit to CMS the additional documents they requested related to the deferral letter soon.  HHSC staff is working with their leadership to provide information to stakeholders on next steps, including reaching out to elected officials, etc.  HHSC will continue working directly with the affected regions and providers and holding bi-weekly calls every other Friday at 1 pm to discuss (as needed) with the anchors, EWC members, and hospital associations for any updates on deferral.

20.  Dates pertinent to this payment: ◦ 12/04/14 – Last day to submit your IGT into TexNet ◦ 12/05/14 – IGT settlement date ◦ 12/15/14 – Pay transferring hospitals ◦ 12/31/14 – Pay all other UC Providers- Public entities will be paid as soon as possible after 12/15/14, with the private entities also being paid as soon as possible but no later than 12/31/14  Once you have entered your IGT into TexNet you will receive a receipt that HHSC refers to as the Trace Sheet. HHSC asks that ALL IGT entities send the following information to the UC Tools mailbox at uctools@hhsc.state.tx.us by 5:00 PM on December 4, 2014: ◦ Trace Sheet (send a pdf) ◦ DY3 Advance UC Allocation Form (send the excel file) ◦ Category 4 Certification (send a signed pdf) ◦ Learning Collaborative Certification (send a signed pdf)