Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter D - TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM › Division 1 - GENERAL › Section 354.1602 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following terms, when used in this subchapter, have
						the following meanings unless the context clearly indicates otherwise.
(1) Administrative Cost Claiming Protocol--A
					 document that explains the process the State will use to determine
					 administrative costs incurred under the waiver.
(2) Anchor--The governmental entity
					 identified by HHSC as having primary administrative responsibilities on behalf
					 of a Regional Healthcare Partnership (RHP).
(3) Centers for Medicare and Medicaid
					 Services (CMS)--The federal agency within the United States Department of
					 Health and Human Services responsible for overseeing and directing Medicare and
					 Medicaid, or its successor.
(4)
					 Delivery System Reform Incentive Payment (DSRIP)--An incentive payment related
					 to the development or implementation of a program of activity that supports an
					 RHP's efforts to enhance access to health care, the quality of care, and the
					 health of patients and families the RHP serves. A DSRIP payment is not
					 considered patient-care revenue and is not offset against Disproportionate
					 Share Hospital expenditures or other expenditures related to the cost of
					 patient care.
(5) Demonstration
					 year--A 12-month period beginning October 1 and ending September 30.
(6) Domain--A group of similar measures in
					 DSRIP Category 4.
(7) DSRIP
					 pool--Funding available to RHP participants under the waiver to compensate them
					 for the value of DSRIP projects.
(8) DSRIP project--An activity selected from
					 the RHP Planning Protocol for implementation in an RHP plan.
(9) Governmental entity--A state agency or a
					 political subdivision of the state, such as a city, county, hospital district,
					 hospital authority, or state entity.
(10) HHSC--The Texas Health and Human
					 Services Commission or its designee.
(11) Independent assessor--An entity
					 contracted with HHSC to provide assistance with the mid-point assessment and
					 ongoing compliance monitoring.
(12)
					 Intergovernmental transfer (IGT)--A transfer of public funds from a
					 governmental entity to HHSC.
(13)
					 IGT entity--A governmental entity that provides an IGT to fund the non-federal
					 share of a waiver payment.
(14)
					 Medicaid provider--An entity approved by HHSC to provide Medicaid
					 services.
(15) Metric--A
					 quantitative or qualitative indicator of progress from a baseline toward
					 achieving a milestone.
(16)
					 Milestone--An objective of DSRIP project performance comprised of one or more
					 metrics.
(17) Participant--An
					 entity participating in an RHP. A participant may be an IGT entity, a
					 performer, or another stakeholder.
(18) Performer--A Medicaid provider that
					 implements one or more DSRIP projects.
(19) Physician group practice--Any business
					 entity, including a partnership, professional association, or corporation,
					 organized under Texas law and established for the purpose of practicing
					 medicine in which two or more physicians licensed in Texas are members of the
					 practice.
(20) Program Funding and
					 Mechanics Protocol (PFM Protocol)--A document containing the DSRIP program
					 guidelines as agreed upon by HHSC and CMS.
(21) Public funds--Funds derived from taxes,
					 assessments, levies, investments, and other public revenues within the sole and
					 unrestricted control of a governmental entity. Public funds do not include
					 gifts, grants, trusts, or donations, the use of which is conditioned on
					 supplying a benefit solely to the donor or grantor of the funds.
(22) Regional Healthcare Partnership (RHP)--A
					 collaboration of interested participants that work collectively to develop and
					 submit to the state a regional plan for health care delivery system reform.
					 Regional Healthcare Partnerships will support coordinated, efficient delivery
					 of quality care and a plan for investments in system transformation that is
					 driven by the needs of local hospitals, communities, and populations.
(23) RHP allocation--An amount of DSRIP funds
					 allocated to a specific RHP during the DSRIP planning process.
(24) RHP plan--A multi-year plan submitted to
					 HHSC and CMS, as further described in §
											RSA 354.1621 of this
					 subchapter (relating to RHP Plan).
(25) RHP Planning Protocol--A master list of
					 potential DSRIP projects with applicable milestones and metrics.
(26) Uncompensated Care (UC) hospital--A
					 hospital eligible to be a performer that chooses to receive only UC
					 payments.
(27) Uncompensated Care
					 (UC) pool--Funding available to certain RHP participants, as well as dental and
					 ambulance providers, under the waiver to defray uncompensated care
					 costs.
(28) Waiver--The Texas
					 Healthcare Transformation and Quality Improvement Program demonstration waiver
					 under §1115 of the Social Security Act.