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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 354MEDICAID HEALTH SERVICES
SUBCHAPTER DTEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM
DIVISION 4DSRIP
RULE §354.1635DSRIP Project Valuation

(a) Each individual DSRIP project and domain must include a rational monetary value. That value is determined by the performer within the strictures described in this subsection and the PFM Protocol.

  (1) Except as described in paragraph (2) of this subsection, a hospital performer must ensure that project values comport with the following funding distribution:

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  (2) A hospital that is exempted from Category 4 reporting may allocate the Category 4 funding to Categories 1, 2, or 3.

  (3) A non-hospital performer must ensure that the project values comport with the following funding distribution:

Attached Graphic

  (4) A Category 1 or 2 DSRIP project may be valued at no more than the greater of 10% of a performer's Pass One allocation or $20 million in total for demonstration years two through five. For DSRIP projects conducted under the collaboration options, the project may be valued at no more that the greater of the sum of 10% of each collaborator's Pass One allocation or $20 million in total for demonstration years two through five. For three-year DSRIP projects, the total value for any pair of Category 1 and 3 or Category 2 and 3 projects may be no more than $20 million for demonstration years three through five.

  (5) Milestones for a Category 1 or 2 DSRIP project must be valued equally within a demonstration year.

(b) All Category 3 milestones within a demonstration year must be valued equally beginning with the third demonstration year. Category 3 valuation is determined as follows:

  (1) A performer must assign a minimum percentage of the sum of the funds originally assigned to all Category 3 outcomes in the first approved RHP plan to the Category 3 outcomes associated with each Category 1 and 2 project.

  (2) The minimum percentage is determined through the formula: minimum percentage = avg% x .5, where "avg%" is the total number of the performer's Category 1 and 2 DSRIP projects divided by 100.

  (3) HHSC may grant an exception to the minimum percentage requirement if such an exception is necessary for the performer to retain proportional valuation between Category 3 outcomes and the related Category 1 and 2 DSRIP projects.

  (4) Once the performer determines the percentage of its available Category 3 funding to assign to the Category 3 outcomes associated with a Category 1 or 2 DSRIP project, HHSC will allocate an equal amount of Category 3 funds to each outcome, and also to each milestone for that outcome in a given demonstration year.

  (5) Category 3 funding must be split among "pay for reporting" and "pay for performance" milestones as follows:

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(c) For the third, fourth, and fifth demonstration years, a performer may allocate an added 5% of funding to Category 4 only when the performer reports on the optional domain as it is described in the RHP Planning Protocol.


Source Note: The provisions of this §354.1635 adopted to be effective September 30, 2014, 39 TexReg 7570

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