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Harris Health System plans to serve more patients via Medicaid waiver

The story about what they’re going to do leaves a few details out, however.

Harris Health System leaders plan to serve 100,000 new patients in the next three years. That is a 37 percent increase from today, and is particularly ambitious when you consider how many patients the system added in the last year: about 500.

To bridge the enormous gap by the end of 2016, the county hospital district is counting on state and federal approval of a $1.2 billion plan that represents the ambitions of health care providers throughout the region. The plan grows out of the federal government’s decision to grant Texas a waiver from Medicaid rules, allowing it to reimburse providers for charity care and for delivering care in new ways.

The plan, awaiting approval in May, envisions unprecedented cooperation between the district and local private and nonprofit providers.

“That’s a major undertaking. We’re very committed to it. We feel it’s very doable,” Harris Health CEO David Lopez said. “We cannot do it all by ourselves. We need partners with us to help us address the needs of our community.”

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Among the district’s proposals awaiting approval: Build nine new primary care clinics during the next three years, build “quick” clinics next to its emergency rooms where patients who are not in crisis can be seen, outsource more primary care visits to private clinics, and leverage federal funds to support Memorial Hermann and Texas Children’s Hospital’s expansion of primary care services.

Members of Harris County Commissioners Court, which appoints the hospital district’s board, say the waiver plans are too slow in cutting the backlog of patients who cannot get primary care appointments. That waiting list, first identified in fall 2011, is estimated between 91,000 and 104,000 a year.

Commissioner El Franco Lee last week issued a memo with the phrases “reduce waiting lists” and “get patients moving through the system” underlined, calling on Lopez to cut the backlog by outsourcing more doctor visits.

I had a few questions about this after I read the story, so I sent some inquiries to the Harris Health System’s media relations email address. Here are the questions I sent, along with the answers I got:

1. The article says that “the county hospital district is counting on state and federal approval of a $1.2 billion plan”. Where is the money for this coming from? Are there new funding sources being sought, or is this a repurposing of existing funds?

Answer: The $1.2 billion plan in the article refers to the Delivery System Reform Incentive Payments (DSRIP) projects available under the 1115 Medicaid Transformational Waiver Program. Harris Health System serves as the anchor entity for the regional planning for several counties in SE Texas. The Waiver primarily does two things: 1) expands Medicaid managed care to the entire state 2) replaces the Upper Payment Limit (UPL) program with two new pools of funding, The Uncompensated Care Pool and the DSRIP Pool. Detailed information about the proposed local regional health plan may be found at www.SETexasRHP.com.

2. What entities are being asked to approve this plan? What exactly are they being asked to approve? What happens if they reject some or all of it?

Answer: The state of Texas and U.S. Centers for Medicare and Medicaid Services (CMS) will approve all plans.

3. The story says that this plan is unrelated to the Affordable Care Act. How will the plan be affected if the state changes course and decides to pursue Medicaid expansion, or a law is passed that grants counties the authority to pursue it on their own?

Answer: The 1115 Medicaid Transformational Waiver Program should not be affected by Medicaid expansion since it is unrelated. Detailed information about the 1115 Medicaid Transformational Waiver at-large, may also be found at the state’s Web site.

4. Are details of this plan available on the HHS website? If not, is there a document you could send to me with plan details?

Answer: Detailed information about the proposed local regional health plan may be found at www.SETexasRHP.com.

In other words, if you want to know more, you’re going to need to get your wonk on. State Rep. Garnet Coleman has discussed the 1115 waiver before – see here and here for two examples – and there’s some further discussion here. Basically, this is about delivering health care services via public hospitals and their partners more effectively and efficiently, with some extra federal funds available. It’s not fully clear how this will all work out, and there won’t be a decision on the waiver request until May, but this is what’s coming. Let’s hope it lives up to its promise.

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