Public Input Process Needed for Major Health Care Waiver

Submitted by Andrea Earl on Wed, 2011-10-26 14:33

Cover Texas Now and other organizations are signing on to letter requesting theTexas HHSC to establish an ongoing dialogue process for informing the public and receiving broad stakeholder input on policy development related to Texas’ July 2011 application for a Section 1115 Demonstration Waiver to the Centers for Medicare and Medicaid Services (CMS). Advocates are concerned there is no formal process for keeping stakeholders informed as well as providing for meaningful input into policy before its adoption.  

The 1115 Medicaid waiver is a major provision in the health care omnibus bill, SB 7, passed during the 82nd legislative session. The waiver provides flexibility for Texas to expand risk-based managed care statewide and preserve Upper Payment Level (UPL) funding for hospitals. 

HHSC’s proposed waiver encompasses plans for statewide expansion of Medicaid managed care, creation of Regional Healthcare Partnerships, and transition to quality-based payment systems for managed care and hospitals. It also includes plans to divert savings generated by the proposed changes into a pool to cover uncompensated care costs for hospitals and other providers.  

The waiver incorporates current managed care programs and provides authority for managed care expansions in September 2011 and March 2012.   The Waiver benefits Texas by:

  • Protecting current Texas UPL funds .
  • Making available additional funding for system investment over 5 years.
  • Placing decision regarding health care delivery system improvements in the hands of local hospitals and hospital districts. (Rather than a top down one size fits all approach)
  • Helping drive down inflation by ensuring hospitals are paid based on uncompensated care costs, not charges,
  • Achieving accountability and transparency for billions of dollars in Texas UPL funding.

To learn more about the 1115 Waiver please access 1115 fact sheet.  If you are interested in signing on to the public particpation request please read our letter to view contact information. To read HHSC’s Waiver proposal click here.