Denton County Judge

July 24, 2012 Thomas M. Suehs Executive Commissioner

T EXAS HEALTH AND H UMAN S ERVI CES COMMlSSION

4900 North Lamar Boulevard Austin, Texas 78751 Re: Request by Denton County to Move to RHP Nine under HHSC' s Waiver

Dear Commissioner Suehs: The citizens of Denton County appreciate your leadership and guidance as the Texas Health and Human Services Commission (HHSC) implements the Texas Healthcare Transformation and Quali. Improvement Program (Waiver) to ensure access to healthcare services by the most vulnerable population in our communities-the uninsured and Medicaid beneficiaries. Although implementation of the Waiver is moving at an extremely rapid pace, Denton County continues to remain engaged in the developme t process and the impact the Waiver will have on our community and its providers. To that end, one ofth key components of the implementation of the Waiver is each county' s participation in a regiona, l healthcare partnership (RHP). When HHSC released its preliminary RHP map in February, Denton County initially requested th2t HHSC place it with other suburban counties north of the Metroplex along the Oklahoma border. Tht decision was influenced by a variety of factors , including the uncertainty of the role of RHP anchors and their control over local healthcare objectives. As we have learned more about the Waiver and details have been clarified, Denton County has revisited its RHP placement to assess how the Waiver can best enhance the delivery system reforms in our community. Based on the significant flow of our residents into Dall s County to receive healthcare services, particularly for high acuity trauma services, our Commissionets and I have decided that a move to RHP 9 is in the best interest of our residents and our providers . n particular, several of our hospitals have historically collaborated with the Dallas County Hospital Distri( t and the move to RHP 9 would facilitate their continued participation under DSRIP and UC. In essenc ~o, we have concluded that it is in the best interest of our county and the performing providers in Denton County to be reassigned to RHP 9. Denton County appreciates the investment and continued work that Collin County has provided as t e anchor of RHP 18 and we support their desire to remain a separate RHP. Please let me know if you ha e any questions or need additional information from me.

Mary Hom Denton County Judge cc: Lisa Kirsch, HHSC Billy Millwee, HHSC

Courthouse-on-the-Square 110 West Hickory Denton, Texas 76201 (940) 349-2820 Fax (940) 349-2821 www.dentoncounty.com