(a) For any DSRIP project in Category 1 or 2, a performer
must select at least one process milestone and at least one improvement
milestone, as described in the Program Funding and Mechanics Protocol
(PFM Protocol). This subsection does not apply to the first demonstration
year.
(1) Every DSRIP project must include a metric for quantifiable
patient impact for the fifth demonstration year.
(2) Every three-year DSRIP project must include a metric
for quantifiable patient impact for both the fourth and fifth demonstrations
years.
(3) The quantifiable patient impact metric must include
a certain level of Medicaid and low-income patients when specified
by HHSC and CMS.
(b) A performer that selects a DSRIP project from Category
1 or 2 must also perform in Category 3. A hospital that selects a
DSRIP project from Category 1 or Category 2 must also perform in Category
4.
(c) A performer must have at least one Category 3 outcome,
selected in accordance with the RHP Planning Protocol, related to
each of its Category 1 and Category 2 projects.
(1) A Category 3 outcome must be appropriate for the
patient population in the related DSRIP project.
(2) A single Category 3 outcome may relate to more
than one Category 1 or Category 2 DSRIP project.
(3) In the third demonstration year, a performer may
modify a previously selected, or choose a new, Category 3 outcome
based on the revised RHP Planning Protocol.
(A) The RHP Planning Protocol will designate each outcome
as either "pay for performance" or "pay for reporting".
(B) In the third demonstration year, each outcome must
contain two process milestones. One process milestone must require
the performer to provide a status update. The other process milestone
must establish a baseline upon which future outcome improvement is
measured.
(C) In the fourth and fifth demonstration years, each
"pay for performance" outcome must contain one milestone and each
"pay for reporting" outcome must contain two milestones.
(i) Every "pay for performance" outcome must contain
an achievement target for the fourth and fifth demonstration years.
(ii) The achievement target must be chosen in accordance
with the standard target methodology as described in the RHP Planning
Protocol.
(iii) A performer may request to set an achievement
target different from those described in the standard target methodology.
Such a request may only be granted by HHSC if the performer provides
a compelling justification.
(iv) Every "pay for reporting" outcome must have an
associated alternate improvement activity, which is either a population
focused priority measure or a stretch activity, as described in the
RHP Planning Protocol.
(D) If performance on a Category 3 "pay for performance"
outcome in demonstration year three exceeds the achievement target
for the fifth demonstration year, the performer must either increase
the achievement target for the fifth demonstration year or add an
alternate improvement activity, as described in the RHP Planning Protocol.
(E) A performer must report progress on improving Category
3 outcomes in the fourth and fifth demonstration years.
(d) To fulfill its obligations under Category 4, a
hospital, unless exempted by HHSC in accordance with the PFM Protocol,
must report on a set of required domains.
(1) Potentially Preventable Admissions (PPAs), Potentially
Preventable Readmissions (PPRs), Potentially Preventable Complications
(PPCs), Emergency Department (ED), and Hospital Consumer Assessment
of Healthcare Providers and Systems (HCAHPS) are all required domains.
(2) Reporting for all required domains, except PPCs,
must begin in the third demonstration year. Reporting for PPCs must
begin in the fourth demonstration year.
(3) If a performer does not have a population for a
Category 4 measure large enough to produce statistically valid data
as described in the RHP Planning Protocol, that performer is not required
to report the data for that particular Category 4 measure.
(4) A performer may choose to report on the additional
optional domain described in the RHP Planning Protocol.
(e) A UC hospital must participate in an annual learning
collaborative and report on a subset of Category 4 measures.
(1) The required subset of Category 4 measures consists
of three domains: Potentially Preventable Admissions (PPAs), Potentially
Preventable Readmissions (PPRs), and Potentially Preventable Complications
(PPCs).
(A) If a hospital fails to report on the three domains
by the last quarter of the applicable demonstration year, the hospital
forfeits one quarter of its UC payments for that demonstration year.
(B) A hospital may request from HHSC a six-month extension
from the end of the demonstration year to report any outstanding Category
4 measures. The hospital will receive the fourth-quarter UC payment
only if all outstanding required Category 4 measures are reported
within that six-month extension.
(2) A hospital under this subsection is not eligible
to receive DSRIP for Category 4 reporting.
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Source Note: The provisions of this §354.1633 adopted to be effective October 31, 2012, 37 TexReg 8453; amended to be effective September 1, 2013, 38 TexReg 5431; amended to be effective September 30, 2014, 39 TexReg 7570 |