| (B) Select a PFPM. Under this option, 100 percent of
the Category 3 outcome's value is P4P of the selected PFPM.
(7) If a Category 3 outcome is designated as maintenance
with an associated stretch activity in DY5, 100 percent of the Category
3 outcome's value is for statistically significant maintenance of
the baseline.
(8) If a Category 3 outcome is designated as P4P in
DY5, performance year (PY) 3 is the 12-month period immediately following
the PY2 approved for use in DYs 3-5, or a performer may request, by
a date to be determined by HHSC, to use DY6A as PY3. PY4 is the 12-month
period immediately following PY3.
(9) If a Category 3 outcome is designated as P4R in
DY5, PY3 is the 12-month period immediately following the PY2 approved
for use in DYs 3-5.
(10) If a Category 3 outcome is designated as P4P in
DY5, the outcome's goal is set as an improvement over the baseline
from DYs 3-5 to be achieved in PY3, or PY4 if not fully achieved in
PY3.
(A) One of the following methodologies is used to set
the outcome's goal, as described in the RHP Planning Protocol:
(i) Quality Improvement System for Managed Care (QISMC);
(ii) Improvement over self (IOS); or
(iii) IOS - Survey.
(B) If an outcome is designated as QISMC in DY5, the
outcome's PY3 goal is calculated as follows, using the baseline, minimum
performance level (MPL), and high performance level (HPL) that were
used for goal setting in DYs 3-5:
Attached Graphic
(C) If an outcome is designated as IOS in DY5, the
outcome's PY3 goal is a 12.5 percent gap closure towards perfect over
the baseline.
(D) If an outcome is a P4P survey-based outcome in
outcome domain 10 or 11 as defined in the RHP Planning Protocol, and
is designated as IOS-survey in DY5, the outcome's PY3 goal is calculated
as follows, using the reporting scenario approved for goal setting
in DY5:
Attached Graphic
(E) If an outcome has an HHSC approved alternate achievement
request in DY5, the performer must submit to HHSC, by a date determined
by HHSC in a form determined by HHSC, a request to use a PY3 goal
that is a continuation of the goals approved in DYs 4-5. Such requests
will be approved by HHSC on a case-by-case basis.
(F) If an outcome is designated as QISMC in DY5, with
a baseline that is below the MPL, and the performer is measuring a
population substantially dissimilar from the population used to establish
the MPL benchmark, the performer may submit, by a date determined
by HHSC in a form determined by HHSC, an alternate achievement request
to set the PY3 goal as a 12.5 percent gap closure towards perfect
over the baseline.
(11) Partial payment for a Category 3 P4P outcome is
available in quartiles as defined in the RHP Planning Protocol, measured
between the outcome's PY1 goal and PY3 goal.
(A) Each Category 3 P4P outcome has an associated achievement
milestone that is assigned an achievement value based on the performer's
achievement of the outcome's goal as follows:
(i) if 100 percent of the goal is achieved, the achievement
milestone is assigned an achievement value of 1.0;
(ii) if at least 75 percent of the goal is achieved,
the achievement milestone is assigned an achievement value of 0.75;
(iii) if at least 50 percent of the goal is achieved,
the achievement milestone is assigned an achievement value of 0.5;
(iv) if at least 25 percent of the goal is achieved,
the achievement milestone is assigned an achievement value of 0.25;
or
(v) if less than 25 percent of the goal is achieved,
the achievement milestone is assigned an achievement value of 0.
(B) The percent of the goal achieved is determined
as follows:
Attached Graphic
(i) If an outcome is approved to use a baseline established
in DY4, partial payment will be measured over a PY1 equivalent goal.
The PY1 equivalent goal will follow the QISMC or IOS goal calculations
for PY1 as approved in the RHP Planning Protocol.
(ii) If a QISMC outcome has a PY3 goal that was determined
using the improvement floor, partial payment will be measured over
the PY1 equivalent goal. If a higher rate indicates improvement for
the outcome, the PY1 equivalent goal is the baseline plus 40 percent
of the improvement floor. If a lower rate indicates improvement for
the outcome, the PY1 equivalent goal is the baseline minus 40 percent
of the improvement floor.
(iii) If an IOS - Survey outcome is approved to use
goal setting Scenario 2 or Scenario 3, partial payment will be measured
over a PY1 equivalent goal. The PY1 equivalent goal fill follow the
IOS goal calculations for PY1 as approved in the RHP Planning Protocol.
(12) Performers may carry forward Category 3 milestones
from DY6A to DY6B and DY7.
(f) The following Category 4 requirements must be met
in DY6A:
(1) Requirements for Category 4 are the same as the
requirements for Category 4 Reporting Domains (RDs) 1-5 in DY5.
(2) If a performer's Category 4 value is greater than
10 percent of the performer's total value, the funds in excess of
the 10 percent will be redistributed to Category 3.
(3) The optional RD6 will be removed as it was required
to value Category 4 at the 15 percent maximum in DYs 3-5.
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