(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
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