Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 354 - MEDICAID HEALTH SERVICES › Subchapter D - TEXAS HEALTHCARE TRANSFORMATION AND QUALITY IMPROVEMENT PROGRAM › Division 7 - DSRIP PROGRAM DEMONSTRATION YEARS 7-8 › Section 354.1713 - Category C Requirements for Performers

Current through Reg. 49, No. 28; July 12, 2024
(a) Requirements for hospitals and physician
					 practices.
(1) Measure Bundle and measure
					 selection.
(A) A hospital or physician
					 practice, with the exception of those described in subparagraph (J) of this
					 paragraph, must select Measure Bundles from the Hospital and Physician Practice
					 Measure Bundle Menu of the Measure Bundle Protocol in accordance with the
					 requirements in subparagraphs (B) - (I) of this paragraph in the RHP plan
					 update for its RHP.
(B) Each
					 Measure Bundle is assigned a point value as described in the Measure Bundle
					 Protocol.
(C) A hospital or
					 physician practice is assigned a minimum point threshold (MPT) for Measure
					 Bundle selection as described in paragraphs (6) and (7) of this
					 subsection.
(D) A hospital or
					 physician practice must select Measure Bundles worth enough points to meet its
					 MPT in order to maintain its total valuation for DY7 and DY8. If a hospital or
					 physician practice does not select Measure Bundles worth enough points to meet
					 its MPT, its total DY7 valuation will be reduced proportionately across its RHP
					 Plan Update and Categories B-D funds for DY7, and its total DY8 valuation will
					 be reduced proportionately across its Categories B-D funds for DY8, based on
					 the point values of the Measure Bundles it selects.
(E) A hospital or physician practice may only
					 select a Measure Bundle for which its denominators for the baseline measurement
					 period for at least half of the required measures in the Measure Bundle have
					 significant volume.
(F) A hospital
					 or physician practice with a valuation greater than $2,500,000 per
					 demonstration year (DY) for DY7-8 must:
(i)
					 select at least one Measure Bundle with at least one required three-point
					 measure for which its denominator for the baseline measurement period has
					 significant volume; or
(ii) select
					 at least one Measure Bundle with at least one optional three-point measure for
					 which its denominator for the baseline measurement period has significant
					 volume, and select at least one optional three-point measure in that Measure
					 Bundle for which its denominator for the baseline measurement period has
					 significant volume.
(G) A
					 hospital or physician practice with an MPT of 75 must select at least one
					 Measure Bundle with at least one population-based clinical outcome measure as
					 specified in the Measure Bundle Protocol.
(H) A hospital or physician practice may only
					 select an optional measure in a selected Measure Bundle for which its
					 denominator for the baseline measurement period has significant
					 volume.
(I) Only a hospital with a
					 valuation less than or equal to $2,500,000 per DY for DY7-8 may select a
					 Measure Bundle identified as a rural Measure Bundle in accordance with the
					 requirements in the Measure Bundle Protocol.
(J) If a hospital or physician practice 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 or physician practice may
					 request HHSC approval to select measures, rather than Measure Bundles, from the
					 Measure Bundle Protocol. The hospital or 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 the Centers
					 for Medicare and Medicaid Services (CMS). If HHSC and CMS, as appropriate,
					 approve such a request, the following requirements apply:
(i) the hospital's or physician practice's
					 total valuation for DY7 and DY8 may be reduced;
(ii) the hospital or physician practice must
					 select measures from the following menus of the Measure Bundle Protocol in
					 accordance with the requirements in clauses (iii) - (v) of this subparagraph in
					 the RHP plan update for its RHP:
(I) the
					 Measure Bundles on the Hospital and Physician Practice Measure Bundle
					 Menu;
(II) the Community Mental
					 Health Center Measure Menu; or
(III) the Local Health Department Measure
					 Menu;
(iii) each measure
					 in a Measure Bundle on the Hospital and Physician Practice Measure Bundle Menu,
					 and each measure on the Community Mental Health Center Measure Menu and the
					 Local Health Department Measure Menu, is assigned a point value as described in
					 the Measure Bundle Protocol;
(iv)
					 the hospital or physician practice is assigned an MPT for measure selection as
					 described in paragraphs (5) and (6) of this subsection; and
(v) the hospital or physician practice must
					 select measures worth enough points to meet its MPT in order to maintain its
					 total valuation for DY7 and DY8. If the hospital or physician practice does not
					 select measures worth enough points to meet its MPT, its total DY7 valuation
					 will be reduced proportionately across its RHP Plan Update and Categories B-D
					 funds for DY7, and its total DY8 valuation will be reduced proportionately
					 across its Categories B-D funds for DY8, based on the point values of the
					 measures it selects.