| (ii) update reporting on related strategies associated
with each measure or group of measures.
(C) A performer that demonstrates good cause may request
in the RHP plan update submission to be exempted from reporting its
performance on a measure for the Medicaid-only payer type or the LIU-only
payer type as specified in the Program Funding and Mechanics Protocol.
(D) A performer that demonstrates good cause may submit
a RHP plan update modification request to HHSC to be exempted from
reporting its performance on a measure for the Medicaid-only payer
type or the LIU-only payer type as specified in the Program Funding
and Mechanics Protocol.
(5) Goal achievement milestones. Payment for a P4P
measure's goal achievement milestone is based on the performer's performance
on the measure for the MLIU payer type.
(A) A performer that demonstrates good cause may request
in the RHP plan update submission that payment for a P4P measure's
goal achievement milestone be based on the performer's performance
on the measure for the all-payer, Medicaid-only, or LIU-only payer
type as specified in the Program Funding and Mechanics Protocol.
(B) A performer that demonstrates good cause may submit
a RHP plan update modification request to HHSC to change the payer
type on which payment for a P4P measure's goal achievement milestone
is based as specified in the Program Funding and Mechanics Protocol.
(g) Methodology for P4P measure goal setting.
(1) A P4P measure's goals are set as an improvement
over the baseline.
(2) A P4P measure is designated as either Quality Improvement
System for Managed Care (QISMC) or Improvement over Self (IOS) as
specified in the Measure Bundle Protocol. A P4P measure designated
as QISMC has a defined High Performance Level (HPL) and Minimum Performance
Level (MPL) based on national or state benchmarks.
(3) If a P4P measure is selected for DY7-10, the goals
for its goal achievement milestones for DY9-10 are set as follows:
Attached Graphic
(4) If a P4P measure is newly selected for DY9-10,
the goals for its goal achievement milestones for DY9-10 are set as
follows:
Attached Graphic
(5) If a performer received HHSC approval to use a
numerator of zero for the baseline measurement period for a DY7-8
P4P measure, and the performer decides to continue that measure in
DY9-10, the goals for the DY9 and DY10 goal achievement milestones
are determined in accordance with paragraph (3) of this subsection
using an updated baseline that is set at the PY1 rate.
(h) Carry forward policy.
(1) Carry forward of reporting. If a performer does
not report a measure's baseline reporting milestone or performance
year reporting milestone during the first reporting period after the
end of the milestone's measurement period, the performer may request
to carry forward reporting of the milestone to the next reporting
period.
(2) Carry forward of achievement.
(A) A performer may request to carry forward achievement
of a measure's DY9 goal achievement milestone so that the DY9 goal
achievement milestone may be achieved in PY3 or PY4, with the exception
described in subparagraph (B) of this paragraph.
(B) If a measure newly selected for DY9-10 has a delayed
baseline measurement period, a performer will carry forward achievement
of its goal achievement milestone so that the DY9 goal achievement
milestone may be achieved in PY4.
(C) The performer must report the carried forward achievement
of a measure's goal achievement milestone during the first reporting
period after the end of the milestone's carried forward measurement
period.
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