| (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:
(A) the valuation for the DY7 goal achievement milestone
is equal to 50 percent of the valuation for the Measure Bundle divided
by the number of measures in the Measure Bundle for which the hospital's
or physician practice's denominator has significant volume, so that
the valuations for the DY7 goal achievement milestones for the measures
in the Measure Bundle for which the hospital's or physician practice's
denominator has significant volume are equal; and
(B) the valuation for the DY8 goal achievement milestone
is equal to 75 percent of the valuation for the Measure Bundle divided
by the number of measures in the Measure Bundle for which the hospital's
or physician practice's denominator has significant volume, so that
the valuations for the DY8 goal achievement milestones for the measures
in the Measure Bundle for which the hospital's or physician practice's
denominator has significant volume are equal.
(3) Measures with multiple parts. Some P4P measures
have multiple parts, as described in the Program Funding and Mechanics
Protocol and Measure Bundle Protocol.
(A) A measure with multiple parts has one baseline
reporting milestone per DY, one PY reporting milestone per DY, and
multiple goal achievement milestones per DY.
(B) The valuation for each measure part's goal achievement
milestone is equal to the measure's total goal achievement milestone
valuation divided by the number of measure parts so that the measure
parts' goal achievement milestone valuations are equal.
(C) All measure parts' baseline reporting milestones
must be reported during the same reporting period.
(D) All measure parts' PY reporting milestones must
be reported during the same reporting period.
(E) Each measure part's goal achievement milestone
will have its own goal. Therefore, the percent of goal achieved, as
described in §354.1719 of this division (relating to Disbursement
of Funds) will be determined for a measure part's goal achievement
milestone independently of the percent of goal achieved for the other
measure parts' goal achievement milestones.
(4) A performer must report a baseline for a measure,
and HHSC must approve the reported baseline for reporting purposes,
before a performer can report PY1 (or PY2 if HHSC approved the use
of a delayed baseline measurement period for the measure).
(A) A performer must adhere to measure specifications
and maintain a record of any variances approved by HHSC prior to reporting
a baseline for a measure.
(B) HHSC's approval of a reported baseline for reporting
purposes does not constitute approval for a performer to report a
measure outside measure specifications. If at any point HHSC or the
independent assessor finds that a performer is reporting a measure
outside measure specifications, reporting milestone payment and goal
achievement milestone payment may be withheld or recouped while the
performer works to bring reporting into compliance with measure specifications.
(5) A performer must report a P4P measure's reporting
milestone and goal achievement milestone for a given PY during the
same reporting period, with exceptions for P4P measures with a delayed
baseline measurement period.
(f) Measure eligible denominator population.
(1) Each Measure Bundle for hospitals and physician
practices has a target population as specified in the Measure Bundle
Protocol.
(2) A measure's eligible denominator population must
include all individuals served by the performer's system during a
given measurement period that are included in the performer's DSRIP-attributed
population and the target population for a measure for hospitals and
physician practices, and that meet the measure's specifications as
specified in the Measure Bundle Protocol.
(3) A performer may not use a performer-specific facility,
co-morbid condition, age, gender, or race/ethnicity subset not otherwise
specified in the Measure Bundle Protocol.
(4) Reporting milestones. A performer must report its
performance on a measure for the all-payer, Medicaid-only, and Low-income
Uninsured-only (LIU-only) payer types to be eligible for payment of
the measure's reporting milestones.
Cont'd... |
