In December 2011, the Centers for Medicare and Medicaid Services (CMS) approved the Texas Health and Human Services Commission (HHSC) Healthcare Transformation and Quality Improvement Program 1115 demonstration waiver. As it pertains to Community Centers like Integral Care, this waiver aims to:
- Transform the health care delivery system for low income Texans, and
- Increase access to quality behavioral health services as a recognized means to improve both individual and system level outcomes.
The Waiver will be in effect through September 30, 2016.
Regional Planning, Local Collaboration for Health Care
The waiver contains provisions that require public hospitals and other local stakeholders establish Regional HealthPartnerships (RHPs) throughout the state and identifying anchors to serve as the coordinating point for developing regional health plans and submitting them to HHSC. Based on community needs, regional plans will include efficient and effective local solutions designed to reduce costs and improve outcomes. Once approved by HHSC and the CMS, the regional plan will serve as the vehicle for receiving new federal funding as incentive payments for local projects.
RHPs are comprised of public and private hospitals and participating providers. These RHPs will each write a regional plan that will identify and address areas for improvement and innovation in the health care delivery system.
Central Health: Region 7 Anchor
HHSC has identified Central Health as the anchor of a region in Central Texas. This region will include Bastrop, Caldwell, Fayette, Hays, Lee and Travis Counties. In its role as anchor, Central Health will be responsible for certain administrative tasks, including holding meetings, collecting and reporting data, and liaising with HHSC.
For more information, a comprehensive listing of information or for questions, please go to: http://texasregion7rhp.net
The Role of Community Centers
Community Centers fulfill important roles under the 1115 Transformation Waiver.
IGT Entity. Like public hospitals and other governmental entities, Centers have the ability to transfer locally managed state and local dollars to draw down federal funding for DSRIP projects. This process is called an Intergovernmental Transfer, or IGT.
Performing Provider. As a public Medicaid provider, Community Centers receive direct payment from HHSC when DSRIP metrics are achieved.
Regional Health Plan Partner. As an IGT Entity and Performing Provider, Community Centers are involved in the RHP process. Community Centers will contribute to the assessment of community need and work collaboratively with local partners, including consumers, advocates and private providers, to plan and implement innovative and effective solutions for addressing behavioral health care needs in the region.
Integral Care DSRIP Projects
The following is a comprehensive listing of Integral Care's proposed DSRIP (see DSRIP description below) projects. Visit Central Health's website for a comprehensive listing of regional projects.
- Integration of Primary and Behavioral Health Care Services in Dove Springs
- Mobile Crisis Outreach Team (MCOT) Expansion
- Community Behavior Support Team
- Expand Specialty Behavioral Health Prescriber Capacity
- Hospital and Jail Alternative Project (Crisis Residential)
- Implementation of Chronic Disease Prevention
- Integrated Health Peer Support Expansion
- Introduce, Expand, or Enhance Telemedicine
- Mental Health First Aid and Suicide Prevention Training
About the Delivery System Reform Incentive Payment (DSRIP) Pool
The waiver program has multiple parts, but the key component for increasing access to behavioral health services is called the Delivery System Incentive Reform Payment (DSRIP) pool. HHSC established a menu of projects that qualify for funding under the DSRIP pool and continues to emphasize the importance of behavioral health. The pool of funds for all DSRIP programs are estimated at $500 million in Year 1, increasing to $3.1 billion in Year 5, contingent upon available local matching funds.
“HHSC expects behavioral health-related projects to play a large role in the waiver and encourages BH stakeholders to engage in RHP planning.” HHSC presentation to Senate Health and Human Services Committee, May 2012.
Potential DSRIP projects include expansion of integrated physical and behavioral health clinics, crisis stabilization services, capacity at current clinics, telemedicine, health information exchange, workforce development and peer support. In addition, DSRIP may fund services to populations with mental health diagnosis and functional limitations that are not eligible for current state funded services.
Quality Adjusted Life Years (QALY's)
For an authoratative paper on QALY's, click here.