| (A) A CMHC must select measures from the Community
Mental Health Center Measure Menu of the Measure Bundle Protocol.
(B) Each measure is assigned a point value as described
in the Measure Bundle Protocol.
(C) A CMHC is assigned an MPT for measure selection
as described in paragraph (3) of this subsection.
(D) A CMHC must select measures worth enough points
to meet its MPT in order to maintain its total valuation for DY7 and
DY8. If a CMHC does not select measures worth enough points to meet
its MPT, its total DY7 valuation will be reduced proportionately across
its RHP Plan Update and Categories B-D funds for DY7, and its total
DY8 valuation will be reduced proportionately across its Categories
B-D funds for DY8, based on the point values of the measures it selects.
(E) A CMHC may only select a measure for which its
denominator for the baseline measurement period has significant volume.
(F) A CMHC must select at least two measures.
(G) A CMHC with a valuation greater than $2,500,000
per DY for DY7-8 must select at least one three-point measure.
(2) DSRIP-attributed population. A CMHC must determine
its DSRIP-attributed population to be applied to its selected measures
as specified in the Measure Bundle Protocol.
(3) Measure valuation. A CMHC may allocate its Category
C valuation among its selected measures, provided the following requirements
are met:
(A) The valuation for each selected measure must be
greater than or equal to (the Category C valuation divided by the
number of selected measures) multiplied by 0.75.
(B) The valuation for each selected one-point measure
must be less than or equal to the Category C valuation divided by
the number of selected measures.
(C) The valuation for each selected three-point or
four-point measure must be less than or equal to (the Category C valuation
divided by the number of selected measures) multiplied by 1.25.
(D) If a CMHC allocates to a measure a percentage of
its Category C valuation that is one percent greater than the Category
C valuation divided by the number of selected measures, the CMHC must
provide sufficient justification as specified in the Program Funding
and Mechanics Protocol.
(4) Milestone valuation. The measure milestones and
corresponding valuations for DY7-8 are as described in subsection
(e) of this section.
(5) MPTs. A CMHC's MPT is the lesser of:
(A) the CMHC's DY7 valuation divided by the standard
point valuation ($500,000); or
(B) 40.
(c) Requirements for local health departments (LHDs).
(1) Measure selection.
(A) An LHD must select measures from:
(i) the Local Health Department Measure Menu of the
Measure Bundle Protocol; or
(ii) its DY6 Category 3 pay-for-performance (P4P) measures.
(B) An LHD may not select the same measure from both
the Local Health Department Measure Menu of the Measure Bundle Protocol
and its DY6 Category 3 P4P measures.
(C) If an LHD's DY6 Category 3 P4P measures include
multiple versions of the same measure, the LHD may select multiple
versions of that measure, but the points associated with that measure
will only count once toward the LHD's MPT.
(D) Each measure on the Local Health Department Measure
Menu is assigned a point value as described in the Measure Bundle
Protocol.
(E) Each LHD DY6 Category 3 P4P measure is assigned
a point value as described in the Measure Bundle Protocol.
(F) An LHD is assigned an MPT for measure selection
as described in paragraph (4) of this subsection.
(G) An LHD must select measures worth enough points
to meet its MPT in order to maintain its total valuation for DY7 and
DY8. If an LHD does not select measures worth enough points to meet
its MPT, its total DY7 valuation will be reduced proportionately across
its RHP Plan Update and Categories B-D funds for DY7, and its total
DY8 valuation will be reduced proportionately across its Categories
B-D funds for DY8, based on the point values of the measures it selects.
(H) An LHD may only select a measure for which its
denominator for the baseline measurement period has significant volume.
(I) An LHD must select at least two measures.
(J) An LHD with a valuation of more than $2,500,000
per DY for DY7-8 must select at least one three-point measure.
(2) DSRIP-attributed population. An LHD must determine
its DSRIP-attributed population to be applied to its selected measures
as specified in the Measure Bundle Protocol.
(3) Measure valuation. An LHD may allocate its Category
C valuation among its selected measures, provided the following requirements
are met:
(A) The valuation for each selected measure must be
greater than or equal to (the Category C valuation divided by the
number of selected measures) multiplied by 0.75.
(B) The valuation for each selected one-point measure
must be less than or equal to the Category C valuation divided by
the number of selected measures.
(C) The valuation for each selected three-point or
four-point measure must be less than or equal to (the Category C valuation
divided by the number of selected measures) multiplied by 1.25.
(D) If an LHD allocates to a measure a percentage of
its Category C valuation that is one percent greater than the Category
C valuation divided by the number of selected measures, the LHD must
provide sufficient justification as specified in the Program Funding
and Mechanics Protocol.
(4) Milestone valuation. The measure milestones and
corresponding valuations for DY7-8 are as described in subsection
(e) of this section.
(5) MPTs. An LHD's MPT is the lesser of:
(A) the LHD's DY7 valuation divided by the standard
point valuation ($500,000); or
(B) 20.
(d) Measurement periods.
(1) Baseline measurement periods. The baseline measurement
period for a measure is calendar year 2017 with the following exceptions:
(A) the baseline measurement period for a DY6 Category
3 P4P measure selected by a LHD is DY6;
(B) a performer that demonstrates good cause may request
for a measure to have a shorter baseline measurement period consisting
of no fewer than six months as specified in the Program Funding and
Mechanics Protocol and HHSC guidance;
(C) a performer that demonstrates good cause may request
for a measure to have a delayed baseline measurement period that ends
no later than September 30, 2018, as specified in the Program Funding
and Mechanics Protocol and HHSC guidance; and
(D) any other exception specified in the Measure Bundle
Protocol or one of its appendices.
(2) Performance measurement periods. The performance
measurement periods for a P4P measure are as follows:
(A) Performance Year (PY) 1 for a measure is calendar
year 2018 unless otherwise specified in the Measure Bundle Protocol
or one of its appendices.
(B) PY2 for a measure is calendar year 2019 unless
otherwise specified in the Measure Bundle Protocol or one of its appendices.
(C) PY3 for a measure is calendar year 2020 unless
otherwise specified in the Measure Bundle Protocol or one of its appendices.
(3) Reporting measurement periods. The reporting measurement
periods for a pay-for-reporting (P4R) measure are as follows unless
otherwise specified in the Measure Bundle Protocol:
(A) Reporting Year (RY) 1 for a measure is DY7; and
(B) RY 2 for a measure is DY8.
(e) Measure milestones.
(1) The milestones and corresponding valuations for
DY7-8 are as follows, with the exceptions specified in paragraphs
(2) and (3) of this subsection:
Attached Graphic
(2) If a hospital's or physician practice's denominator
for a required measure in a selected Measure Bundle for the baseline
measurement period or a performance measurement period has insignificant
volume, the valuation for the measure's goal achievement milestone
for the DY is redistributed among the goal achievement milestones
for the measures in the Measure Bundle for which the hospital's or
physician practice's denominator for the baseline measurement period
or performance measurement period has significant volume for the applicable
DY. The valuations for the goal achievement milestones for the measures
in the Measure Bundle for which the hospital's or physician practice's
denominator has significant volume for the DY are calculated as follows:
Cont'd... |
