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.
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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 |