Implementing Medicaid’s 1115 Waiver for Texas’ JPS Health Network

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The Problem

John Peter Smith (JPS) Health Network is a major public health care delivery system in Fort Worth, Texas and is the anchor entity for Region 10’s Regional Healthcare Partnership (RHP), part of Texas’ 1115 Medicaid waiver. The Delivery System Reform Incentive Payment (DSRIP) funding pool of the waiver allows providers that participate in regional planning and implementation of significant care delivery transformation projects to receive incentive payments.

As an anchor entity, JPS was responsible for providing intergovernmental transfer funding to other providers to fulfill federal waiver financing requirements, facilitating stakeholder engagement, overseeing a nine-county needs assessment, encouraging the development of sustainable projects that meet DSRIP criteria, and assisting performing providers in identifying and quantifying specific clinical and quality outcomes.


The Solution

To meet these responsibilities, JPS engaged COPE Health Solutions to provide comprehensive technical and project management support to the region’s 27 performing providers and community stakeholders to ensure successful waiver implementation. Our team’s role included crosswalking the RHP protocol menu to individual provider interest and capabilities; discussion and technical assistance with identifying feasible and appropriate clinical outcomes; and gap analysis/restructuring of DSRIP projects to meet community needs and CMS requirements. In addition, our team handled document management, quality assurance, and editing of the final RHP plan.

We also convened webinars and conducted phone calls and in-person meetings to facilitate provider understanding of protocols. We worked iteratively to review and assist with completing project narratives and outcome(s) selection to ensure that all Region 10 projects reflected evolving state and federal project expectations.

Highlights of our approach:

  • Conducted initial needs assessment (included extensive data collection activities and facilitation of individual county-level community meetings to identify and achieve consensus on the region’s highest priority needs)
  • Drafted RHP plan and prepared the document for final submission
  • Co-developed and managed communication strategy for internal and external stakeholders
  • Provided technical assistance to 27 providers, including clinical evaluation
  • Facilitated communications between providers and HHSC
  • Developed learning collaborative strategy for the region



In total, the Region 10 plan developed with COPE Health Solutions’ expertise included 111 projects linked to 207 individual clinical outcomes proposed by 27 performing providers. The Region 10 plan was the fifth in the state to be approved by HHSC and sent to CMS for review. In early May 2013, CMS approved 76 projects at their initial value, with 23 projects needing technical revision.