1 Tex. Admin. Code § 354.1602 - Definitions
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.
Notes
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