| (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
(B) the valuation for the DY10 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 DY10 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 §354.1757 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) For measures newly selected for DY9-10, a performer
must report a baseline for a measure, and HHSC must approve the reported
baseline for reporting purposes, before a performer can report PY3
(or PY4 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, race, or ethnicity subset not otherwise
specified in the Measure Bundle Protocol.
(4) Reporting milestones.
(A) A hospital or physician practice must do the following
to be eligible for payment of a measure's reporting milestones for
each DY, with the exceptions described in subparagraphs (C) and (D)
of this paragraph:
(i) report its performance on the measure for the all-payer,
Medicaid-only, and Low-income Uninsured-only (LIU-only) payer types;
and
(ii) update reporting on related strategies associated
with each Measure Bundle.
(B) A CMHC or LHD must do the following to be eligible
for payment of a measure's reporting milestones for each DY, with
the exceptions described in subparagraphs (C) and (D) of this paragraph:
(i) report its performance on the measure for the all-payer,
Medicaid-only, and Low-income Uninsured-only (LIU-only) payer types;
and
Cont'd... |
