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RULE §354.1602Definitions

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 §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.

Source Note: The provisions of this §354.1602 adopted to be effective October 31, 2012, 37 TexReg 8453; amended to be effective September 1, 2013, 38 TexReg 5431; amended to be effective September 30, 2014, 39 TexReg 7570

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