Archive for October, 2012

2012 Advance Waiver Payments and IGT Schedule

Tuesday, October 2nd, 2012

To avoid potential financial hardship for providers due to the timing of Texas Healthcare Transformation and Quality Improvement Waiver (Transformation Waiver) demonstration year one (DY 1) uncompensated care (UC) payments, the Health and Human Services Commission (HHSC) will calculate advance UC payments for certain eligible hospitals and physician group practices. Eligible providers include: 1) hospitals that participated in the Disproportionate Share Hospital (DSH) program in federal fiscal year (FFY) 2012; and/or 2) providers that received a transition waiver payment in FFY 2012.

HHSC has estimated the amount of funds available for 2012 Advance UC Payments by subtracting a UC Payment Reserve of $660,940,285, and Total Year-to-Date (YTD) Transition Waiver Payments of $1,865,268,882 from the Total FFY 2012 UC Pool of $3.7 billion. The balance of approximately $1,173,790,833 in the UC pool is allocated for the calculation of the 2012 advance waiver payment caps.

* The UC Payment Reserve represents the amount of UC waiver pool funds that HHSC is holding in reserve for processing the final 2012 UC payments after providers have submitted UC Tools.

2012 Advance Waiver Payment Caps:

Attached are the 2012 Advance Waiver Payment Caps and associated maximum state share for submitting Intergovernmental Transfers (IGT) for the Advance Waiver payment. The payment methodology for calculating the 2012 Advance Waiver Payment Caps is based upon each eligible provider’s Total Volume of Payments which is equal to the provider’s FFY 2012 Transition Waiver Cap (for non-DSH hospitals and for physician group practices) or the provider’s 2012 DSH Room (for hospitals receiving a 2012 DSH payment). A provider’s 2012 Advance Waiver Payment Cap is equal to the provider’s annualized 2011 Upper Payment Limit payments. A hospital’s 2012 DSH Room is equal to the hospital’s 2012 interim hospital specific limit (HSL) less its total 2012 DSH payments. Providers that are not eligible for Transition Waiver payments and did not receive a 2012 DSH payment are not eligible for advance waiver payments.

After determining each provider’s Total Volume of Payments, HHSC then applied a proportional 28 percent reduction, and, for providers eligible for Transition Waiver payments, subtracted Year-to-Date (YTD) 2012 Transition Waiver Payments. In cases where a provider’s YTD 2012 Transition Waiver Payments exceeded their “haircut caps” at 72 percent of Total Volume of Payments, the 2012 Advance Waiver Payment Cap will equal zero and the provider will not receive a 2012 Advance Waiver Payment. This does not mean that the provider is not eligible to receive a final 2012 UC payment based on remaining Transition Waiver cap or based upon submission of a UC Tool.

Final UC payments will be determined after all completed UC Tools are analyzed. Information regarding payments related to final UC payments will be provided in a separate notice after the UC tool deadline of October 26.

Please be advised that if a non-Transition Waiver hospital receives a 2012 Advance Waiver Payment, but does not submit a UC Tool to HHSC, the hospital will be subject to recoupment of 100 percent of their 2012 Advance Waiver Payment. Therefore, non-Transition Waiver hospitals that do not intend to submit a DY1 UC Tool should not IGT for a 2012 Advance Waiver Payment. A Transition Waiver hospital is a hospital that has been receiving Transition Waiver payments; a non-Transition Waiver hospital is a hospital that was not eligible to receive any Transition Waiver payments in FFY 2012.

Every private hospital that receives waiver payments must execute an Indigent Care Affiliation Agreement with the governmental entity that provides the IGT for any type of waiver payment (transition, UC or DSRIP). Private hospitals that received transition payments already have an affiliation agreement on file with HHSC. New affiliation agreements must be submitted if the affiliation terms have changed, if the parties to the affiliation have changed since the last agreement was sent to HHSC or if the private hospital has never submitted an affiliation agreement to HHSC. For more information and links to all forms, please see the “Private Hospital Checklist.”

If a private hospital receives waiver payments and, 1) HHSC does not receive or have on file an affiliation agreement, or 2) HHSC does not receive both required certifications submitted either with the UC Tool by the deadline of October 26 or with the Regional Healthcare Partnership (RHP) plan by the deadline established for submittal of the RHP plan, the 2012 Advance Waiver Payment will be subject to recoupment.

Furthermore, it should be noted that all providers that receive Transition Waiver and/or Advance Waiver Payments in FFY 2012 may be subject to payment adjustments if final UC allowable costs for all providers exceed the Total FFY 2012 UC Pool. In this case, the payment adjustment would represent a proportional reduction of all FFY 2012 Transition Waiver and UC payments.

Please find below the following IGT schedules for public, private and state institutions for mental disease (IMD) hospitals:

Large Urban Hospitals, Rural Hospitals, and Physician Groups:
Monday, October 8 – Enter IGT into Tex Net (send Trace Sheets to HHSC)
Tuesday, October 9 – IGT Settlement Date (IGT sweeps)
Wednesday, October 10 – HHSC confirms IGTs and begins payment calculations
Wednesday, October 17 – Payment Issue Date – Large Urban Hospitals & Physicians
Tuesday, October 23 – Payment Issue Date – Rural Hospitals

Private Hospitals and State IMD’s:
Wednesday, October 24 – Enter IGT into Tex Net (send Trace Sheets to HHSC)
Thursday, October 25 – IGT Settlement Date (IGT sweeps)
Tuesday, October 26 – HHSC confirms IGTs and begins payment calculations
Friday, November 16 – Payment Issue Date – Private Hospitals

HHSC will contact the state owned hospitals to schedule the general revenue transfer for the 2012 Advance Waiver Payments next week. If you have any questions regarding the 2012 Advance Waiver Payment Caps calculations or IGT schedule, please contact Jill Seime at (512) 491-1863 or Kellie Stephens at (512) 491-1862.

TORCH and LoneStart Wellness Announce the “All In…We Win!” Initiative

Tuesday, October 2nd, 2012

Today is the official start of the “All In…We Win” Wellness Initiative that is sponsored by TORCH and LoneStart Wellness. Several hospitals represented on the TORCH Board of directors and other member hospitals are already signed up to participate. We invite you to sign-up as well this week and be part of our biggest wellness movement yet! We are trying to get as many hospitals as possible onboard by this Friday, so act now.

You may have noticed that more and more people are talking about wellness lately. We think the tide is turning and it is becoming clearer to many that the issue over health reform has too much to do with insurance and death panels and not enough to do with simply keeping our population a little bit healthier.

Overcoming obesity and chronic illness is not as difficult as it seems and TORCH has a partner organization called LoneStart Wellness that has completely eliminated any barriers to your participation. You can now sign up your hospital employees in a proven wellness program for $2 per employee per month. Best of all, the results that some of our members have had speak for themselves. Their testimonials can be found below.

This approach is tailor-made for your involvement in the 1115 Waiver as well. Imagine, being able to move the needle on your entire community’s BMI with minimal cost and effort. Just be sure to include community health and wellness in your DSRIP plan, test out this program with your hospital employees and when you’re ready, roll the program out to your larger community.

Sign-up today and be a part of the initial roll-out of All In…We Win. Download the participation form. Simply fill it in and return it to the TORCH office. Now is the time to take a stand and show that rural hospitals are proactively addressing our nation’s need for REAL health reform and it starts with wellness.

We plan to aggregate the results of this initiative over the coming months and present them to the legislature and to our members at the 2013 TORCH Annual Conference and Trade Show in Dallas this coming April.

Please help us to make sure we have a critical mass of hospitals committed to making “All In…We Win” a success. The more hospitals that participate, the better story we can tell about how TORCH-member hospitals are improving the health of all rural Texans. Thank you.

Do The Math Fact Sheet

“We implemented the LoneStart Team Esteem Challenge twice at Rice Medical Center at the regular fee and both times we were confident that our investment paid for itself not only in documented BMI reduction, but in improved morale and engagement. At $2 per employee per month, this new All In . . . We Win initiative is an incredible opportunity.  This is not only the right thing to do, it’s the smart thing to do.” ~ Richard Hoeth, FACHE, President, Southwest Rural Hospital Consultants and Senior Hospital Management Consultant, TMSI

“When I took over at Faith Community Hospital I knew I needed to do two things pretty quickly—reduce employee health care costs and build morale. By implementing the LoneStart Team Esteem Challenge, I took a giant step toward both goals.  We implemented it again this year in preparation for the 1115 Waiver, since it is such a perfect fit.  I urge all my colleagues to join this initiative.  It’s a unique opportunity to benefit from a proven wellness strategy at a fraction of what you would pay elsewhere for a less effective program.” ~ Frank Beaman, CEO, Faith Community Hospital

“What impresses me most is the fact that five years after we completed our LoneStart Team Esteem Challenge, our healthier behaviors are still evident.  We continue to have great  participation in what’s become our daily wellness conversation and my hospital continues to derive the many benefits of a fitter, happier, more engaged team.  A new culture has taken hold here that is reflected in my hospital kitchen, my bottom line, and in the lives of my employees and their families.  LoneStart Wellness is the best investment I’ve made as a hospital administrator.” ~ Raz Cook, MSN, FACHE, Administrator, ETMC Fairfield