| (a) Introduction. The Texas Healthcare Transformation
and Quality Improvement Program §1115(a) Medicaid demonstration
waiver provides for supplemental payments to many types of providers.
In order to ensure that such payments are made properly, HHSC will
contract with one or more independent entities to monitor the Delivery
System Reform Incentive Payment (DSRIP) program. This section describes
the method by which HHSC will gain the source of the non-federal share
of payments to reimburse the independent entity for its administrative
expenses. For purposes of this rule, the definitions in §354.1602
of this title (relating to Definitions) apply, except where otherwise
indicated.
(b) Funding for Delivery System Reform Incentive Payment
program monitoring. HHSC will allocate an intergovernmental transfer
(IGT) amount to each DSRIP IGT entity to fund DSRIP monitoring activities.
(1) HHSC will determine the amount of the IGT allocation
in each demonstration year for each IGT entity. The amount of the
IGT allocation for each IGT entity will be calculated using the following
formula: IGT Allocation = (AffiliatedValue/DYValue) x TotalIGT, where:
(A) "AffiliatedValue" is the portion of the value for
which the IGT entity agreed to fund the non-federal share for all
DSRIP projects that the IGT entity is affiliated with for a particular
demonstration year; and
(B) "DYValue" is the value for all DSRIP projects in
the state for the same demonstration year as used in subparagraph
(A) of this paragraph.
(C) "TotalIGT" is the total amount of IGT necessary
for monitoring activities in a demonstration year, as determined by
HHSC. This amount may not be greater than $5 million.
(2) The values utilized in paragraph (1) of this subsection
are the official values as of January 1 of the calendar year in which
the calculation occurs.
(3) The full IGT allocation for monitoring will be
requested the first time an IGT entity provides an IGT for a demonstration
year.
(4) No IGT may be allocated for the waiver monitoring
program prior to the first DSRIP reporting opportunity for the third
demonstration year.
(5) An IGT entity may choose to either provide the
IGT allocation from an IGT intended to fund a DSRIP payment or in
addition to an IGT to fund a DSRIP payment.
(c) Return of unused intergovernmental transfers. The
balance of any allocation not used to fund monitoring activities will
be returned to the IGT entities. The amount returned is calculated
on a pro rata basis in accordance with the amount of such entities'
intergovernmental transfers intended to fund the DSRIP monitoring
program for the demonstration year for which the refund is made.
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