<<Prev Rule

Texas Administrative Code

Next Rule>>
TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354MEDICAID HEALTH SERVICES
SUBCHAPTER DTEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM
DIVISION 8DSRIP PROGRAM DEMONSTRATION YEARS 9-10
RULE §354.1753Category C Requirements for Performers

    (D) A CMHC must select measures worth enough points to meet its MPT in order to maintain its total valuation for DY9 and DY10. If a CMHC does not select measures worth enough points to meet its MPT, its total DY9 valuation will be reduced proportionately across its Categories B-D funds for DY9, and its total DY10 valuation will be reduced proportionately across its Categories B-D funds for DY10, based on the point values of the measures it selects.

    (E) A CMHC may request to delete a maximum of 20 points worth of its DY7-8 measures for DY9-10 with good cause. In this context, good cause is defined as:

      (i) a significant system change; or

      (ii) updated community needs.

    (F) A CMHC may only select a measure for which its denominator for the baseline measurement period has significant volume.

    (G) A CMHC must select at least two measures.

    (H) A CMHC with a valuation greater than $2,500,000 per DY for DY7-8 and a valuation of more than $2,000,000 for DY10 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. All measures selected by a CMHC for DY9-10 are valued equally.

  (4) Milestone valuation. The measure milestones and corresponding valuations for DY9-10 are as described in subsection (e) of this section.

  (5) MPTs.

    (A) A CMHC's MPT is the lesser of:

      (i) the CMHC's DY10 valuation divided by the standard point valuation ($500,000); or

      (ii) 40.

    (B) A CMHC's MPT for DY9-10 must not be reduced by more than 10 points from the CMHC's MPT for DY7-8.

(c) Requirements for local health departments (LHDs).

  (1) Measure selection.

    (A) An LHD must select measures from the Local Health Department Measure Menu of the Measure Bundle Protocol, unless the LHD selected one of its DY6 Category 3 pay-for-performance (P4P) measures for DY7-8, in which case the LHD may select that measure for DY9-10.

    (B) Each measure on the Local Health Department Measure Menu is assigned a point value as described in the Measure Bundle Protocol.

    (C) Each LHD DY6 Category 3 P4P measure is assigned a point value as described in the Measure Bundle Protocol.

    (D) An LHD is assigned an MPT for measure selection as described in paragraph (4) of this subsection.

    (E) An LHD must select measures worth enough points to meet its MPT in order to maintain its total valuation for DY9 and DY10. If an LHD does not select measures worth enough points to meet its MPT, its total DY9 valuation will be reduced proportionately across its Categories B-D funds for DY9, and its total DY10 valuation will be reduced proportionately across its Categories B-D funds for DY10, based on the point values of the measures it selects.

    (F) An LHD may request to delete a maximum of 20 points worth of its DY7-8 measures for DY9-10 with good cause. In this context, good cause is defined as:

      (i) a significant system change; or

      (ii) updated community needs.

    (G) An LHD may only select a measure for which its denominator for the baseline measurement period has significant volume.

    (H) An LHD must select at least two measures.

    (I) An LHD with a valuation of more than $2,500,000 per DY for DY7-8 and a valuation of more than $2,000,000 for DY10 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. All measures selected by a LHD for DY9-10 are valued equally.

  (4) Milestone valuation. The measure milestones and corresponding valuations for DY9-10 are as described in subsection (e) of this section.

  (5) MPTs.

    (A) An LHD's MPT is the lesser of:

      (i) the LHD's DY10 valuation divided by the standard point valuation ($500,000); or

      (ii) 20.

    (B) An LHD's MPT for DY9-10 must not be reduced by more than 10 points from the LHD's MPT for DY7-8.

(d) Measurement periods.

  (1) Baseline measurement periods.

    (A) The baseline measurement period for a measure selected for DY7-10 is calendar year 2017 with the following exceptions:

      (i) the baseline measurement period for a DY6 Category 3 P4P measure selected by a LHD is DY6;

      (ii) HHSC approved the 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;

      (iii) HHSC approved the measure to have a delayed baseline measurement period that ended no later than September 30, 2018, as specified in the Program Funding and Mechanics Protocol and HHSC guidance; and

      (iv) any other exception specified in the Measure Bundle Protocol or one of its appendices.

    (B) The baseline measurement period for a measure newly selected for DY9-10 is calendar year 2019 with the following exceptions:

      (i) 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;

      (ii) 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, 2020, as specified in the Program Funding and Mechanics Protocol and HHSC guidance; and

      (iii) 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;

    (D) PY4 for a measure is calendar year 2021 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;

    (B) RY2 for a measure is DY8;

    (C) RY3 for a measure is DY9; and

    (D) RY4 for a measure is DY10.

(e) Measure milestones.

  (1) The milestones and corresponding valuations for DY9-10 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 or numerator for a P4R population-based clinical outcome 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 DY9 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 DY9 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

Cont'd...

Next Page Previous Page

Link to Texas Secretary of State Home Page | link to Texas Register home page | link to Texas Administrative Code home page | link to Open Meetings home page