| (A) 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.
(B) 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) A P4P measure's goals for its goal achievement
milestones are set as follows:
Attached Graphic
(4) A performer may request HHSC approval in the RHP
plan update to use a numerator of zero for certain P4P measures for
the baseline measurement period, as described in the Program Funding
and Mechanics Protocol and Measure Bundle Protocol. If a performer
receives HHSC approval to use a numerator of zero for a P4P measure
for the baseline measurement period, the goal for the DY7 goal achievement
milestone will be equal to the 75th percentile, and the goal for the
DY8 goal achievement milestone will be equal to a 10% gap closure
between the 75th percentile and the HPL, as described in the Measure
Bundle Protocol.
(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 goal achievement milestone so that the DY7 goal achievement
milestone may be achieved in PY1 or PY2, and the DY8 goal achievement
milestone may be achieved in PY2 or PY3, with the exception described
in subparagraph (B) of this paragraph.
(B) If a measure has a delayed baseline measurement
period, a performer will carry forward achievement of its goal achievement
milestone so that the DY7 goal achievement milestone may be achieved
in PY2.
(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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| Source Note: The provisions of this §354.1713 adopted to be effective December 1, 2017, 42 TexReg 6609; amended to be effective April 26, 2018, 43 TexReg 2393; amended to be effective September 1, 2018, 43 TexReg 5497 |
