| (ii) provided at least one encounter or served at least
one individual toward the DSRIP project's DY6A MLIU QPI milestone
goal.
(I) If a DSRIP project's DY6A MLIU QPI milestone is
P4P, and the project does not have a DY5 MLIU-specific QPI metric,
the performer is eligible to report on, and receive payment for, the
DY6A MLIU QPI milestone once the performer has done the following:
(i) achieved or forfeited a DSRIP project's DY5 QPI
metric; and
(ii) achieved the DSRIP project's DY6A MLIU QPI milestone
goal.
(J) If a DSRIP project's DY6A MLIU QPI milestone is
P4P, and the project has a DY5 MLIU-specific QPI metric, the performer
is eligible to report on, and receive payment for, the DY6A MLIU QPI
milestone once the performer has done the following:
(i) achieved or forfeited the DSRIP project's DY5 MLIU-specific
QPI metric; and
(ii) achieved the DSRIP project's DY6A MLIU QPI milestone
goal.
(K) A performer may only begin to count individuals
served or encounters provided toward a DSRIP project's DY6A MLIU QPI
milestone goal after the performer has achieved or forfeited a DY5
QPI metric or a DY5 MLIU-specific QPI metric.
(L) A performer is only eligible to report on, and
receive payment for, a DSRIP project's DY6A MLIU QPI milestone during
DY6A or the DY6A carry forward period.
(4) Non-QPI Milestones.
(A) DSRIP projects must include the following non-QPI
milestones:
(i) project summary and core components, which may
include continuous quality improvement (CQI); and
(ii) sustainability planning, which may include activities
toward furthering the exchange of health information, integration
into managed care, collaboration with other community partners, or
a project level-evaluation.
(B) Performers must attend at least one learning collaborative,
stakeholder forum, or other stakeholder meeting during DY6A and report
on their activities for these milestones in order to be eligible for
milestone payment.
(C) DSRIP projects may report on DY6A non-QPI milestones
only during the second reporting period of DY6A.
(D) DSRIP projects may not carry forward non-QPI milestones
from DY6A to DY6B or DY7.
(e) The following Category 3 requirements must be met
in DY6A:
(1) The Category 3 outcome values are equal to the
Category 3 outcome values for DY5. However, if a performer's Category
4 value is greater than 10 percent of the performer's total value,
the Category 4 funds in excess of the 10 percent will be redistributed
to the performer's Category 3 outcomes proportionately.
(2) If a Category 3 outcome has multiple parts, the
Category 3 outcome's value is equally divided among the parts.
(3) Each Category 3 outcome is designated as pay-for-performance
(P4P), pay-for-reporting (P4R), or maintenance. The direction of an
outcome (positive or negative) necessary to demonstrate improvement
is described in the Category 3 Compendium. An outcome designated as
maintenance was high performing at baseline with no reasonable room
for improvement and was approved to use a milestone structure for
DYs 3-5 that includes an alternate improvement activity.
(4) If a Category 3 outcome is designated as pay-for-performance
(P4P) in DY5, 100 percent of the Category 3 outcome's value is P4P.
(5) If a Category 3 outcome is designated as pay-for-reporting
(P4R) or maintenance with a population focused priority measure (PFPM)
in DY5, 100 percent of the Category 3 outcome's value is P4P of the
PFPM.
(6) If a Category 3 outcome is designated as P4R with
an associated stretch activity in DY5, the performer must choose one
of the following options by a date determined by HHSC in a form determined
by HHSC:
(A) Maintain the Category 3 outcome designated as P4R
from DY5 and select a new stretch activity that does not duplicate
the DY5 stretch activity.
(i) The performer must select a new stretch activity
from the following:
(I) program evaluation (alternate approaches to program
and outcome linkages);
(II) new participation in health information exchange
(HIE) or improvement of existing HIE infrastructure; or
(III) cost analysis and value-based purchasing planning.
(ii) Under this option, 50 percent of the Category
3 outcome's value is P4R of the Category 3 outcome and 50 percent
is for completion of the stretch activity.
(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.
Cont'd... |
