| the Texas Hospital
Uncompensated Care Tool.
(ii) Second, the hospital's statewide hospital ratio
(SHR) is equal to (the hospital's DY10 valuation divided by the sum
of all hospitals' DY10 valuations) divided by the SHF.
(iii) Third, the hospital's MPT is determined as follows:
(I) If the SHR is less than or equal to 3, the MPT
is the lesser of:
(-a-) the DY10 valuation divided by $500,000; or
(-b-) 75.
(II) If the SHR is greater than 3 but less than or
equal to 10, the MPT is the lesser of:
(-a-) (the DY10 valuation divided by $500,000 multiplied
by (the SHR divided by 3); or
(-b-) 75.
(III) If the SHR is greater than 10 and the DY10 valuation
is less than or equal to $15 million, the MPT is the lesser of:
(-a-) the DY10 valuation divided by $500,000 multiplied
by (the SHR divided by 3); or
(-b-) 40.
(IV) If the SHR is greater than 10 and the DY10 valuation
is greater than $15 million, the MPT is the lesser of:
(-a-) the DY10 valuation divided by $500,000 multiplied
by (the SHR divided by 3); or
(-b-) 75.
(B) If a hospital does not have the data needed for
the SHF calculation in paragraph (5)(A)(i) of this subsection, or
if a hospital did not participate in DSRIP during the initial demonstration
period or DY6, its MPT is the lesser of:
(i) the hospital's DY10 valuation divided by $500,000;
or
(ii) 75.
(C) The MPT for a hospital for DY9-10 must not be reduced
by more than 10 points from the hospital's MPT for DY7-8.
(D) If a hospital has a limited scope of practice,
cannot reasonably report on at least half of the required measures
in the Measure Bundle(s) appropriate for it based on its scope of
practice and community partnerships, and consequently cannot meet
its MPT for Measure Bundle selection, the hospital may request HHSC
approval for a reduced MPT equal to the sum of the points for all
the Measure Bundles for which the hospital could reasonably report
on at least half of the required measures in the Measure Bundle. The
hospital must submit a request for such approval to HHSC prior to
the RHP plan update submission, by a date determined by HHSC. Such
a request may be subject to review by the Centers for Medicare &
Medicaid Services (CMS). If HHSC and CMS, as appropriate, approve
such a request, the hospital's total valuation for DY9 and DY10 may
be reduced.
(7) MPTs for physician practices.
(A) The MPT for a physician practice for DY9-10, with
the exception of a physician practice described in subparagraph (C)
of this paragraph, is the lesser of:
(i) the physician practice's DY10 valuation divided
by $500,000; or
(ii) 75.
(B) The MPT for a physician practice for DY9-10 must
not be reduced by more than 10 points from the physician practice's
MPT for DY7-8.
(C) If a physician practice has a limited scope of
practice, cannot reasonably report on at least half of the required
measures in the Measure Bundles appropriate for it based on its scope
of practice and community partnerships, and consequently cannot meet
its MPT for Measure Bundle selection, the physician practice may request
HHSC approval for a reduced MPT equal to the sum of the points for
all the Measure Bundles for which the physician practice could reasonably
report on at least half of the required measures in the Measure Bundle.
The physician practice must submit a request for such approval to
HHSC prior to the RHP plan update submission, by a date determined
by HHSC. Such a request may be subject to review by CMS. If HHSC and
CMS, as appropriate, approve such a request, the physician practice's
total valuation for DY9 and DY10 may be reduced.
(b) Requirements for community mental health centers
(CMHCs).
(1) Measure selection.
(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 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
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