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RULE §354.1695Participants

(a) Anchors.

  (1) An anchor must:

    (A) serve as the RHP's single point of contact with HHSC, except as specified in rule;

    (B) facilitate transparent and inclusive meetings among participants to discuss RHP activities;

    (C) coordinate RHP activities to help ensure that participants properly address both the needs of the region and the requirements placed upon the RHP;

    (D) coordinate the update of the community needs assessment included in the RHP plan and submit the updated community needs assessment to HHSC, as prescribed by HHSC;

    (E) coordinate with the RHP participants to update the RHP plan in accordance with §354.1697 of this division (relating to RHP Plan Update), the Program Funding and Mechanics Protocol, the Measure Bundle Protocol, and all other state or waiver requirements;

    (F) submit the RHP plan update to HHSC, as prescribed by HHSC;

    (G) post the approved RHP plan update to the RHP website;

    (H) develop and submit an annual progress report on behalf of the RHP, in accordance with the Program Funding and Mechanics Protocol and HHSC requirements;

    (I) develop and submit a learning collaborative plan, in accordance with the Program Funding and Mechanics Protocol and HHSC requirements;

    (J) ensure that all confidential information obtained through its role as an anchor remains confidential as required by state and federal laws and regulations;

    (K) ensure that all waiver information provided to it in its capacity as anchor is distributed to the RHP participants; and

    (L) meet all other requirements as specified in the Program Funding and Mechanics Protocol.

  (2) An anchor must not:

    (A) request reimbursement from a Medicaid provider for the discharge of the anchor's responsibilities, although an anchor and other governmental entities within the RHP may agree to share such costs;

    (B) delegate decision-making responsibilities concerning the interpretation of the waiver, HHSC policy, or actions or decisions that involve the exercise of discretion or judgment;

    (C) require any IGT entity to provide DSRIP funds to any performers;

    (D) require any participant to act as a DSRIP performer; or

    (E) prevent or in any way prohibit the collaboration between an IGT entity and a performer.

  (3) An anchor may delegate ministerial functions such as data collection and reporting. Any entity to which ministerial functions are delegated under this subchapter must comply with the roles, responsibilities, and limitations of an anchor.

  (4) In addition to any funds received under §354.1707 of this division (relating to Performer Valuations), an anchor may be reimbursed for the cost of its administrative duties conducted on behalf of the RHP. The anchor must provide an IGT to HHSC for the purpose of obtaining federal matching funds in accordance with the Administrative Cost Claiming Protocol so that it can be reimbursed for such costs. An anchor may not recover more than the anchor's actual costs.

(b) IGT entities. An IGT entity:

  (1) determines the allocation of its IGT funding consistent with state and federal requirements;

  (2) participates in RHP planning;

  (3) if the IGT entity is itself acting as a performer, selects Category C Measure Bundles or measures in accordance with §354.1713 of this division (relating to Category C Requirements for Performers);

  (4) if the IGT entity is not acting as a performer, cooperates with a performer to select Category C Measure Bundles or measures in accordance with §354.1713 of this division;

  (5) provides the non-federal share of DSRIP pool payments for the entities with which it collaborates; and

  (6) may review DSRIP data submitted by associated performers.

(c) Performers. A performer:

  (1) is one of the following provider types:

    (A) hospital;

    (B) physician practice;

    (C) community mental health center; or

    (D) local health department;

  (2) submits to the anchor the information required for the RHP plan update, including the performer's selected Category C Measure Bundles or measures and other required information as described in §354.1697 of this division, the Program Funding and Mechanics Protocol, and the Measure Bundle Protocol;

  (3) implements core activities to achieve the Category C measure goals in the RHP plan update;

  (4) prepares and submits DSRIP data on a semi-annual basis;

  (5) prepares and submits reports as required by HHSC and the Centers for Medicare & Medicaid Services;

  (6) participates in RHP planning; and

  (7) receives DSRIP.

Source Note: The provisions of this §354.1695 adopted to be effective December 1, 2017, 42 TexReg 6609; amended to be effective April 26, 2018, 43 TexReg 2393

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