The document discusses a 1115 Waiver program in Texas aimed at expanding managed care statewide while achieving savings and improving quality. It proposes using 1115 Waiver funds and city matching funds totaling $1.36 million over 4 years to re-establish a sexually transmitted disease clinic in San Angelo's health department. The goals are to increase access to STD testing and treatment, decrease emergency room visits and costs, and locate the clinic centrally near the hospital and transportation center. The health department project would help address high STD rates in Tom Green County and leave fewer treatment options after eliminating an existing STD clinic.

1. City Council
December 4, 201

2. Texas Health Care Transformation and Quality Improvement Program –
1115 Waiver
Background:
2011 Texas Legislature directed TX Health and Human
Services Commission to expand managed care,
achieve savings, and improve quality
1115 Waiver provides flexibility for Texas to expand
managed care statewide while preserving Upper
Payment Limit funding to hospitals.

3. 1115 Waiver Goals
• Expand risk-based managed care statewide
• Support development and maintenance of a
coordinated care delivery system
• Improve outcomes while containing cost
• Improve and prepare the health care infrastructure
increasing access to services
• Transition to quality based payment systems
• Provide a mechanism for improved coordination in the
current indigent care system in advance of health care
reform

4. 1115 Waiver
• Texas was granted authority from the Federal
Government to create a waiver pool, with funds being
distributed through two sub-pools, both of which are
part of a Regional Healthcare Partnership.
1. Uncompensated Care - Hospitals
2. Delivery System Reform Incentive Payment
(DSRIP

5. 1115 Waiver
Regional Health Partnership (RHP) – San Angelo’s RHP
consists of 17 counties: Coke, Coleman, Concho,
Crockett, Irion, Kimble, Mason, McCulloch, Menard,
Pecos, Reagan, Runnels, Schleicher, Sterling, Sutton,
Terrell, Tom Green.
Projects Shall Meet One of the Following Initiatives:
1. Infrastructure Development
2. Program Innovation and Redesign
3. Population-focused improvement
4. Clinical Improvement in care

6. Proposed Project
• Re-establish a Sexually Transmitted Disease Clinic within
San Angelo’s Health Department.
• Requested 1115 Waiver Funds: $960,000 (4 year span)
Must be used to establish or enhance programs, and cannot be
used for maintaining a program.
• Required City Match: $400,000 (4 year span)
Will utilize Health Department’s $100,000 of yearly budgeted
General Fund dollars. This would require Council to continue
funding of the Department at this level for at least the next 4
years. No financial commitment of the City is required beyond
the 4 years proposed.

7. Health Department STD Clinic Project
• Rationale behind choosing project:
• In 2011, according to DSHS Midland sub-office, Tom Green County had
3856 confirmed positive STD cases; therefore with the elimination of the
City’s STD Clinic, hundreds of citizens were left with less options for
testing and treatment.
• Project Description Goals:
• Re-establish an STD Clinic for Testing, Treating and preventing the
spread of STD’s (Chlamydia, Gonorrhea and Syphilis)
• Decrease number of ER visits (keep costs down), and
• Establish the STD Clinic in a Central Location (close to Shannon ER and
the Multi-Modal Transportation Center)
• Project period ends FY2016.