The following terms, when used in this division, have the following
meanings unless the context clearly indicates otherwise.
(1) Alternate improvement activity--An activity that
must be selected in conjunction with a Category 3 outcome designated
as pay-for-reporting (P4R) or maintenance. There are two types of
alternate improvement activities: stretch activities and Population-Focused
Priority Measures (PFPMs).
(2) Baseline--The baseline that HHSC has on record
for a Category 3 outcome, typically the baseline that the performer
most recently submitted to HHSC.
(3) Baseline measurement period--The time period used
to set the baseline for a Category 3 outcome.
(4) Category 3 outcome--An outcome measure for which
a performer can earn Category 3 payments.
(5) Demonstration Year (DY) 6--The initial 15-month
time period, as approved by CMS, for which the waiver is extended
beyond the initial demonstration period, or October 1, 2016 - December
31, 2017.
(A) DY6A--Federal fiscal year (FFY) 2017, or the first
12 months of DY6 (October 1, 2016 to September 30, 2017).
(B) DY6B--The last three months of DY6 (October 1,
2017 to December 31, 2017).
(6) Extension period--The entire time period, as approved
by CMS, for which the waiver is extended beyond the initial demonstration
period.
(7) Federal poverty level--The household income guidelines
issued annually and published in the Federal
Register by the United States Department of Health and Human
Services.
(8) Improvement floor--A fixed value equal to ten percent
of the difference between the minimum performance level (MPL) and
the high performance level (HPL) for a Category 3 outcome. It is used
to set the performance year (PY) goal for certain Category 3 outcomes
designated as pay-for-performance (P4P) and Quality Improvement System
for Managed Care (QISMC) that have a baseline that is either close
to the HPL or above the HPL.
(9) Improvement over self (IOS)--A goal-setting methodology
for certain Category 3 outcomes designated as pay-for-performance
(P4P). Under IOS, an outcome's goal is set as closing the gap between
the baseline and the perfect rate.
(10) Initial demonstration period--The first five DYs
of the waiver, or December 12, 2011, through September 30, 2016.
(11) Medicaid and Low-income or Uninsured (MLIU) Quantifiable
Patient Impact (QPI)--The number of MLIU individuals served, or encounters
provided to MLIU individuals, during an applicable DY that are attributable
to the DSRIP project.
(12) Medicaid and Low-income or Uninsured (MLIU) Quantifiable
Patient Impact (QPI) Goal--The number of MLIU individuals that a performer
intends to serve, or the number of MLIU encounters that a performer
intends to provide, during an applicable DY that are attributable
to the DSRIP project.
(13) Medicaid and Low-income or Uninsured (MLIU) Quantifiable
Patient Impact (QPI) - Specific Metric--A QPI metric in the initial
demonstration period that is specific to counting the MLIU population.
This metric usually represents a subpopulation of another QPI metric
and has a metric ID of I-34.1.
(14) Performance level--The benchmark level used to
determine a Category 3 outcome's performance year (PY) goal relative
to the baseline under the Quality Improvement System for Managed Care
(QISMC) goal-setting methodology. There is a high performance level
(HPL) and minimum performance level (MPL) for each outcome, as described
in the RHP Planning Protocol.
(15) Performance Year (PY)--The 12-month measurement
period that follows the baseline measurement period for a Category
3 outcome. For most outcomes, PY1 is the 12-month period that immediately
follows the baseline measurement period, and PY2 is the 12-month period
that immediately follows PY1.
(16) Population-Focused Priority Measure (PFPM)--A
Category 3 outcome designated as pay-for-performance (P4P) that is
an alternate improvement activity.
(17) Pre-DSRIP baseline--The service volume prior to
the implementation of a DSRIP project, as measured by the number of
individuals served or encounters provided during the 12-month period
preceding the implementation of the DSRIP project. There is a pre-DSRIP
baseline for total QPI and a pre-DSRIP baseline for MLIU QPI.
(18) Quality Improvement System for Managed Care (QISMC)--A
goal-setting methodology for certain Category 3 outcomes designated
as pay-for-performance (P4P). Under QISMC, an outcome's goal is set
as closing the gap relative to the baseline and a high performance
level (HPL) and minimum performance level (MPL) benchmark.
(19) Quantifiable Patient Impact (QPI) Grouping--The
category of the QPI measurement. The category may be either individuals
served or encounters provided.
(20) Reporting Domain (RD)--Category 4 contains five
domains upon which hospital performers must report, as specified in
the Program Funding and Mechanics (PFM) Protocol.
(21) Stretch activity--A pay-for-reporting (P4R) activity
that is an alternate improvement activity.
(22) Total Quantifiable Patient Impact (QPI)--The total
number of individuals served or encounters provided during an applicable
DY that are attributable to the DSRIP project.
(23) Total Quantifiable Patient Impact (QPI) Goal--The
total number of individuals that a performer intends to serve, or
the total number of encounters that a performer intends to provide,
during an applicable DY that are attributable to the DSRIP project.
(24) Uncompensated Care (UC) Hospital--A hospital eligible
to be a performer that is not a performer, but receives UC payments.
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