|(a) Mid-point assessment. An independent assessor will
initiate a mid-point assessment of DSRIP projects prior to the fourth
demonstration year, consistent with the requirements of the PFM Protocol.
(1) The independent assessor will review a DSRIP project
for the following elements:
(A) Compliance with the approved RHP plan.
(B) Compliance with the required core components described
in the RHP Planning Protocol, including continuous quality improvement
(C) Ensuring that activities funded through DSRIP do
not duplicate activities funded through other federal funds.
(D) The clarity of the improvement milestones for the
fourth and fifth demonstration years and those milestones' connection
to DSRIP project activities and patient impact.
(E) The benefit of the DSRIP project to the patients
served by the project, including the Medicaid and uninsured populations.
(F) The opportunity for DSRIP project improvement.
(2) Any change to an RHP plan resulting from this process
will be reviewed by HHSC.
(3) Based upon the recommendations of the independent
assessor, HHSC or CMS may require changes to the RHP plan for the
fourth and fifth demonstration years.
(b) Compliance Monitoring. The independent assessor
will continually monitor DSRIP projects.
(1) In addition to generally monitoring for compliance
with DSRIP program requirements and objectives, the independent assessor
may, at HHSC’s discretion:
(A) review and make recommendations regarding DSRIP
project values determined by HHSC or CMS to be outliers;
(B) provide recommendations to HHSC regarding a request
from a performer to use a Category 3 achievement target that varies
from the standard target setting methodology, as described in §354.1633
of this subchapter (relating to DSRIP Requirements for Performers);
(C) provide secondary review of a request for a substantial
reduction in project scope through plan modification.
(2) All RHP plans are subject to potential audits,
including review by the independent assessor, during ongoing compliance
monitoring. Upon request, performers must have available for review
by the independent assessor, HHSC, and CMS, all supporting data and
back-up documentation demonstrating performance as described under
an RHP plan for DSRIP payments.
(c) Effect on DSRIP Payments. Future payments for a
non-compliant DSRIP project may be withheld in whole or in part until
the necessary changes identified by HHSC or CMS are addressed. In
addition, the findings of the independent assessor may form the basis
of a recoupment of a DSRIP payment. Failure of a performer to provide
supporting documentation of metric or milestone achievement may result
in recoupment of DSRIP payments.