reglab/statecodes huggingface dataset:
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 5 - ACTIONS IN PREPARATION FOR EXTENSION OF THE DSRIP PROGRAM › Section 354.1645 - Electing to Continue a DSRIP Project in the Waiver Extension Period

Current through Reg. 49, No. 28; July 12, 2024
(a) If HHSC determines that a DSRIP project
					 is ineligible to continue in its current form, that DSRIP project may not
					 participate in the transition year. A performer affected by such a
					 determination will have the opportunity to use the funds associated with the
					 DSRIP project beginning in DY7.
(b)
					 For each DSRIP project that HHSC determines is eligible to continue, the
					 performer must indicate, by a date to be determined by HHSC, whether it chooses
					 to:
(1) discontinue the DSRIP project in the
					 transition year; or
(2) continue
					 the DSRIP project in the transition year.
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 5 - ACTIONS IN PREPARATION FOR EXTENSION OF THE DSRIP PROGRAM › Section 354.1647 - Requests for Adjustments to Certain DSRIP Projects

Current through Reg. 49, No. 28; July 12, 2024
(a) Certain DSRIP projects are eligible for
					 an adjustment to the DSRIP project's transition year MLIU QPI goal. These DSRIP
					 projects include:
(1) a DSRIP project that
					 HHSC identifies as underperforming on MLIU in the initial demonstration
					 period;
(2) a DSRIP project that is
					 reporting on individuals or encounters that meet the MLIU definition for the
					 initial demonstration period, but will not meet the MLIU definition for the
					 extension period; and
(3) any other
					 DSRIP project that HHSC determines has a strong justification for an
					 adjustment.
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 5 - ACTIONS IN PREPARATION FOR EXTENSION OF THE DSRIP PROGRAM › Section 354.1649 - Certain Requirements for the Planned Transition Year and their Exceptions

Current through Reg. 49, No. 28; July 12, 2024
(a) To be eligible
					 for the MLIU QPI milestone payment, beginning in the transition year,
					 performers must report for each DSRIP project the MLIU individuals served or
					 encounters provided at the individual or encounter level as opposed to the
					 percentage of total QPI.
(b) There
					 are limited exceptions to this requirement. Performers may request an exception
					 to this requirement by a date to be determined by HHSC. DSRIP projects eligible
					 for an exception include:
(1) a DSRIP project
					 for which the performer did not assess the DSRIP project participants' health
					 insurance coverage or financial status prior to September 30, 2015, and instead
					 used a proxy to estimate the MLIU population served in their October DY4 QPI
					 Reporting Template, and:
(A) utilizes an
					 intervention site that is a school, non-medical social service office (i.e.,
					 shelter), or community health fair;
(B) is in Project Area 1.6 (Enhance Urgent
					 Medical Advice), 2.6 (Implement Evidence-based Health Promotion), or 2.7
					 (Implement Evidence-based Disease Prevention Programs); or
(C) the performer is a Local Health
					 Department that does not bill Medicaid for the types of services provided
					 through the DSRIP project; or
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 6 - HOSPITAL SERVICES › Section 354.1661 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following terms, when used in this division, have the
						following meanings unless the context clearly indicates otherwise.
(1) Alternate improvement activity--An
					 activity that must be selected in conjunction with a Category 3 outcome
					 designated as pay-for-reporting (P4R) or maintenance. There are two types of
					 alternate improvement activities: stretch activities and Population-Focused
					 Priority Measures (PFPMs).
(2)
					 Baseline--The baseline that HHSC has on record for a Category 3 outcome,
					 typically the baseline that the performer most recently submitted to
					 HHSC.
(3) Baseline measurement
					 period--The time period used to set the baseline for a Category 3
					 outcome.
(4) Category 3 outcome--An
					 outcome measure for which a performer can earn Category 3 payments.
(5) Demonstration Year (DY) 6--The initial
					 15-month time period, as approved by CMS, for which the waiver is extended
					 beyond the initial demonstration period, or October 1, 2016 - December 31,
					 2017.
(A) DY6A--Federal fiscal year (FFY)
					 2017, or the first 12 months of DY6 (October 1, 2016 to September 30,
					 2017).
(B) DY6B--The last three
					 months of DY6 (October 1, 2017 to December 31, 2017).
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 6 - HOSPITAL SERVICES › Section 354.1663 - Medicaid and Low-Income or Uninsured (MLIU) Quantifiable Patient Impact (QPI)

Current through Reg. 49, No. 28; July 12, 2024
(a) To qualify as a
					 Medicaid individual for purposes of MLIU QPI, the individual must be enrolled
					 in Medicaid at the time of at least one DSRIP project encounter during the
					 applicable demonstration year (DY).
(b) To qualify as a low-income or uninsured
					 individual for purposes of MLIU QPI, the individual must either be below 200
					 percent of the federal poverty level or must not have health insurance at the
					 time of at least one DSRIP project encounter during the applicable
					 DY.
(c) If an individual was
					 enrolled in Medicaid at the time of one DSRIP project encounter during the
					 applicable DY, and was low-income or uninsured at the time of a separate DSRIP
					 project encounter during the applicable DY, that individual is classified as a
					 Medicaid individual for purposes of MLIU QPI.
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 6 - HOSPITAL SERVICES › Section 354.1665 - Demonstration Year 6 DSRIP Pool Funding and Distribution

Current through Reg. 49, No. 28; July 12, 2024
(a) The DSRIP pool for demonstration year
					 (DY) 6 is $3.875 billion.
(1) The DSRIP pool
					 for DY6A is $3.1 billion.
(2) The
					 DSRIP pool for DY6B is $775 million.
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 6 - HOSPITAL SERVICES › Section 354.1667 - Requirements for Continuing DSRIP Projects

Current through Reg. 49, No. 28; July 12, 2024
(a) A performer's total value for
					 demonstration year (DY) 6A is equal to the performer's total value for DY5 with
					 the following exceptions:
(1) HHSC notifies a
					 performer that a DSRIP project's value may be reduced if the DSRIP project
					 fails to complete DSRIP project or metric goals by the end of DY5.
(2) Performers with a total value less than
					 $250,000 for DY5 may increase their total value to up to $250,000 per each
					 subsequent DY beginning in DY6A. The increase in value is contingent on funds
					 availability as described in §354.1673 of this division (relating to
					 Remaining DSRIP Funds). Categories 1-4 will each be increased proportionately.
					 However, any funds in excess of the 10 percent maximum for Category 4 will be
					 allocated to Category 3. A performer may need to increase a DSRIP project's
					 MLIU QPI goal for DY6A and beyond in order to obtain the increased value.
					 Performers eligible for this option must make this choice by a date to be
					 determined by HHSC.
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 6 - HOSPITAL SERVICES › Section 354.1669 - Requirements for Combining Certain DSRIP Projects

Current through Reg. 49, No. 28; July 12, 2024
(a) Certain DSRIP projects may be eligible to
					 combine based on performer requests to combine. These DSRIP projects must:
(1) be eligible to continue into the
					 extension period;
(2) not exceed a
					 DY6A value of $5 million when combined; and
(3) be one of the following:
(A) cross-regional community mental health
					 center DSRIP projects;
(B) similar
					 DSRIP projects by the same performer; or
(C) similar DSRIP projects by different
					 performers within the same health system.
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 6 - HOSPITAL SERVICES › Section 354.1671 - DSRIP Requirements for Uncompensated Care Hospitals

Current through Reg. 49, No. 28; July 12, 2024
An Uncompensated Care hospital must participate in an
						annual learning collaborative and report on mandatory Category 4 domains as
						described in §
											RSA
						354.1633(e)(1) of this
						subchapter (relating to DSRIP Requirements for Performers).
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 6 - HOSPITAL SERVICES › Section 354.1673 - Remaining DSRIP Funds

Current through Reg. 49, No. 28; July 12, 2024
The funds in the DSRIP pool not allocated to DSRIP
						projects for DY6A will be reallocated.
(1) Funds are reallocated to increase the
					 performer's total value to up to $250,000 per each subsequent demonstration
					 year (DY) beginning in DY6A. Such an increase is only available to performers
					 who have DSRIP projects totaling less than $250,000.
(2) The anchor of an RHP is allocated the
					 greater of RHP allocation as defined in 354.1634(b) of this subchapter
					 (relating to Waiver Pool Allocation) multiplied by $20 million or the following
					 minimum allocations.
(A) A Tier 1 RHP anchor
					 has no minimum DY6A allocation.
(B)
					 A Tier 2 RHP anchor has no minimum DY6A allocation.
(C) A Tier 3 RHP anchor has a minimum DY6A
					 allocation of $1,250,000.
(D) A
					 Tier 4 RHP anchor has a minimum DY6A allocation of $625,000. A Tier 4 RHP's
					 minimum DY6A allocation may be increased to $800,000 if the anchor meets the
					 requirements described in §354.1675(1) of this division (relating to
					 Anchor Requirements).
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 6 - HOSPITAL SERVICES › Section 354.1675 - Anchor Requirements

Current through Reg. 49, No. 28; July 12, 2024
To receive its DY6A anchor payment, an anchor must comply
						with the requirements in this section.
(1) An anchor must submit a DY6A learning
					 collaborative plan in accordance with the PFM Protocol, if it is the anchor of
					 a Tier 1, 2, or 3 region or it is the anchor of a Tier 4 region that wishes to
					 receive the enhanced allocation.
(A) The DY6A
					 learning collaborative plan, at a minimum, must include an annual regional
					 learning collaborative. The learning collaborative must include a focus on
					 DSRIP integration into Medicaid managed care, value-based purchasing,
					 alternative payment models, or sustainability strategies for low-income
					 uninsured. The anchor could also meet this requirement through a workgroup that
					 would be in addition to the annual regional learning collaborative.
(B) Two or more regions may work together to
					 submit a cross-regional DY6A learning collaborative plan.
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 354.1691 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
						division, have the following meanings unless the context clearly indicates
						otherwise.
(1) Core activity--An
					 activity implemented by a performer to improve patient health or quality of
					 care. It may be part of a DSRIP project implemented by a performer during the
					 initial demonstration period that the performer continues in DY7-8, or a new
					 activity implemented by a performer in DY7-8. It may be implemented by a
					 performer to achieve the performer's Category C measure goals or it may be
					 connected to the mission of the performer's organization.
(2) Demonstration Year (DY) 6--Federal fiscal
					 year 2017 (October 1, 2016 - September 30, 2017).
(3) Demonstration Year (DY) 7--Federal fiscal
					 year 2018 (October 1, 2017 - September 30, 2018).
(4) Demonstration Year (DY) 8--Federal fiscal
					 year 2019 (October 1, 2018 - September 30, 2019).
(5) Demonstration Year (DY) 9--Federal fiscal
					 year 2020 (October 1, 2019 - September 30, 2020).
(6) Denominator--As it relates to a Category
					 C measure's volume:
(A) the number of
					 Medicaid and low-income or uninsured (MLIU) cases; or
(B) one of the following, which the performer
					 receives approval from HHSC to use for the measure:
(i) the number of all-payer cases;
(ii) the number of Medicaid cases;
					 or
(iii) the number of low-income
					 or uninsured (LIU) cases.
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 354.1693 - Regional Healthcare Partnerships (RHPs)

Current through Reg. 49, No. 28; July 12, 2024
(a) An RHP has geographic boundaries as
					 prescribed by HHSC.
(b) An RHP is
					 composed of one anchor and other participants, which may include IGT entities,
					 performers, and other regional stakeholders. A single entity may act in
					 multiple roles.
(c) An IGT entity
					 may participate in more than one RHP contingent upon HHSC approval.
(d) A performer may only participate in the
					 RHP plan update for the RHP in which it is physically located. If a performer
					 has physical locations in more than one RHP, the performer may be assigned to a
					 single "home" RHP of its choosing and participate only in the RHP plan update
					 for its "home" RHP.
(e) A provider
					 must participate in an RHP, as described in §354.1717 of this division
					 (relating to Uncompensated Care (UC) Hospital Requirements), to be eligible to
					 receive a UC pool payment. However, HHSC along with the Centers for Medicare
					 & Medicaid Services may approve exceptions to this requirement on a case by
					 case basis.
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 354.1695 - Participants

Current through Reg. 49, No. 28; July 12, 2024
(a) Anchors.
(1) An anchor must:
(A) serve as the RHP's single point of
					 contact with HHSC, except as specified in rule;
(B) facilitate transparent and inclusive
					 meetings among participants to discuss RHP activities;
(C) coordinate RHP activities to help ensure
					 that participants properly address both the needs of the region and the
					 requirements placed upon the RHP;
(D) coordinate the update of the community
					 needs assessment included in the RHP plan and submit the updated community
					 needs assessment to HHSC, as prescribed by HHSC;
(E) coordinate with the RHP participants to
					 update the RHP plan in accordance with §354.1697 of this division
					 (relating to RHP Plan Update), the Program Funding and Mechanics Protocol, the
					 Measure Bundle Protocol, and all other state or waiver requirements;
(F) submit the RHP plan update to HHSC, as
					 prescribed by HHSC;
(G) post the
					 approved RHP plan update to the RHP website;
(H) develop and submit an annual progress
					 report on behalf of the RHP, in accordance with the Program Funding and
					 Mechanics Protocol and HHSC requirements;
(I) develop and submit a learning
					 collaborative plan, in accordance with the Program Funding and Mechanics
					 Protocol and HHSC requirements;
(J)
					 ensure that all confidential information obtained through its role as an anchor
					 remains confidential as required by state and federal laws and
					 regulations;
(K) ensure that all
					 waiver information provided to it in its capacity as anchor is distributed to
					 the RHP participants; and
(L) meet
					 all other requirements as specified in the Program Funding and Mechanics
					 Protocol.
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 354.1697 - RHP Plan Update

Current through Reg. 49, No. 28; July 12, 2024
(a) A performer may
					 receive DSRIP only if HHSC has approved the RHP plan update for the performer's
					 RHP.
(b) An RHP plan update must:
(1) meet the requirements listed in the
					 Program Funding and Mechanics Protocol and the Measure Bundle
					 Protocol;
(2) update the RHP's
					 community needs assessment, referencing sources used;
(3) include a list of IGT entities,
					 performers, UC hospitals, and other stakeholders involved in the development of
					 the RHP plan update;
(4) include
					 certifications that all the information contained within the RHP plan update is
					 true and accurate;
(5) describe the
					 processes used to engage stakeholders including the public meetings held,
					 public posting of the RHP plan update, and the process for submitting public
					 comment on the RHP plan update;
(6)
					 include the total amount of estimated DSRIP funding to be used by demonstration
					 year (DY);
(7) include for each
					 performer:
(A) the definition of the
					 performer's system;
(B) a
					 description of the performer's core activities for DY7-8;
(C) the performer's Category B total Patient
					 Population by Provider (PPP) and MLIU PPP baseline data;
(D) if the performer is a hospital or
					 physician practice, the performer's selected Category C Measure Bundles and
					 measures, and requests for allowable changes to those Measure Bundles and
					 measures, as described in the Program Funding and Mechanics Protocol and
					 Measure Bundle Protocol;
(E) if the
					 performer is a community mental health center or local health department, the
					 performer's selected Category C measures, and requests for allowable changes to
					 those measures, as described in the Program Funding and Mechanics Protocol and
					 Measure Bundle Protocol;
(F) a
					 description of the transition of the performer's DY2-6 projects to
					 DY7-8;
(G) the performer's Category
					 D Statewide Reporting Measure Bundle;
(H) the performer's DSRIP valuation amounts;
					 and
(I) the performer's sources of
					 non-federal funds by category and DY;
(8) include a narrative explaining the
					 performer's rationale for its Category C Measure Bundle and measure selections;
					 and
(9) if the RHP is allocated
					 DY7-8 remaining funds as described in §354.1721 of this division (relating
					 to Remaining Funds for Demonstration Years (DYs) 7-8), the information required
					 by that section.
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 354.1699 - RHP Plan Update Review

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC
					 reviews and assesses each submitted RHP plan update to determine whether it
					 meets the following criteria:
(1) It is in
					 the prescribed format.
(2) It
					 contains all required elements described in the Program Funding and Mechanics
					 Protocol and the Measure Bundle Protocol, and is consistent with the waiver
					 Special Terms and Conditions.
(3)
					 It meets the requirements for Category A - Required Reporting, Category B -
					 MLIU Patient Population by Provider (PPP), Category C - Measure Bundles and
					 Measures, and Category D - Statewide Reporting Measure Bundles, as described in
					 the Program Funding and Mechanics Protocol and the Measure Bundle
					 Protocol.
(4) The funding amount
					 and distribution is in accordance with the Program Funding and Mechanics
					 Protocol.
(5) It is consistent with
					 the goals of the DSRIP program and the objectives of the Medicaid
					 program.
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 354.1701 - RHP Plan Update Modifications

Current through Reg. 49, No. 28; July 12, 2024
A performer may submit a request to HHSC to modify
						elements of the RHP plan update for the performer's RHP prospectively, as
						described in the Program Funding and Mechanics Protocol, including the
						performer's:
(1) System
					 definition;
(2) Category B Medicaid
					 and Low-income Uninsured (MLIU) Patient Population by Provider (PPP);
(3) Category C measure payer types for
					 reporting milestones;
(4) Category
					 C measure payer type for goal achievement milestones;
(5) Category C optional measures if the
					 performer is a hospital or physician practice; or
(6) Category C measures if the performer is
					 a:
(A) community mental health
					 center;
(B) local health
					 department; or
(C) hospital or
					 physician practice that has received approval from HHSC to select measures,
					 rather than Measure Bundles, from the Measure Bundle Protocol as described in
					 §RSA
					 354.1713 of this division (relating to
					 Category C Requirements for Performers).
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 354.1703 - Independent Assessor

Current through Reg. 49, No. 28; July 12, 2024
The independent assessor continually monitors DSRIP
						performers for compliance with DSRIP program requirements and
						objectives.
(1) All RHP plan updates
					 are subject to potential audits, including review by the independent assessor,
					 during ongoing compliance monitoring.
(2) Upon request, performers must have
					 available for review by the independent assessor, HHSC, the Centers for
					 Medicare & Medicaid Services, and any other federal entity all supporting
					 data and back-up documentation demonstrating performance for a milestone as
					 described under an RHP plan update for DSRIP payments.
(3) Failure of a performer to provide
					 supporting documentation demonstrating performance for a milestone in a timely
					 manner may result in recoupment of DSRIP payments or withholding of future
					 DSRIP payments.
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 354.1705 - Categories

Current through Reg. 49, No. 28; July 12, 2024
There are four categories for demonstration years (DYs)
						7-8:
(1) Category A - Required
					 Reporting, which requires performers to report their progress on core
					 activities, alternative payment model arrangements, costs and savings, and
					 collaborative activities, as described in §354.1709 of this division
					 (relating to Category A Requirements for Performers);
(2) Category B - Medicaid and Low-income or
					 Uninsured (MLIU) Patient Population by Provider (PPP), which requires
					 performers to maintain or increase the number of MLIU individuals served, as
					 described in §354.1711 of this division (relating to Category B
					 Requirements for Performers);
(3)
					 Category C - Measure Bundles and Measures, which requires performers to improve
					 their performance on clinical outcome and process measures, as described in
					 §RSA
					 354.1713 of this division (relating to
					 Category C Requirements for Performers); and
(4) Category D - Statewide Reporting Measure
					 Bundles, which requires performers to report on certain measures based on their
					 provider type, as described in §354.1715 of this division (relating to
					 Category D Requirements for Performers).
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 354.1707 - Performer Valuations

Current through Reg. 49, No. 28; July 12, 2024
(a) If a performer
					 participated in DSRIP during the initial demonstration period or DY6, its total
					 valuation per demonstration year (DY) for DY7 and DY8 is equal to its total
					 valuation for DY6 with the following exceptions:
(1) If HHSC determined that a DSRIP project
					 was ineligible to continue in DY6, the performer affected by such a
					 determination may use the funds associated with the DSRIP project beginning in
					 DY7.
(2) If a performer withdrew a
					 DSRIP project between June 30, 2014, and June 30, 2016, the performer may use
					 the funds associated with the DSRIP project beginning in DY7.
(3) If a performer participated in DSRIP
					 during the initial demonstration period but not during DY6 and has a total
					 valuation per DY for DY7-8 less than $250,000, the performer may request in the
					 RHP plan update to increase its total valuation to up to $250,000 per DY for
					 DY7-8.
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 354.1709 - Category A Requirements for Performers

Current through Reg. 49, No. 28; July 12, 2024
A performer must fulfill the following Category A -
						Required Reporting requirements for each demonstration year (DY).
(1) Core activities. A performer must select
					 at least one core activity in the RHP plan update for its RHP that supports the
					 achievement of its Category C measure goals, as described in the Measure Bundle
					 Protocol. The performer must report progress on, and updates to, its selected
					 core activities during the second reporting period of each DY.
(2) Alternative Payment Models (APMs). A
					 performer must report progress toward, or implementation of, APM arrangements
					 with Medicaid managed care organizations or other payers during the second
					 reporting period of each DY.
(3)
					 Costs and savings. A performer with a total valuation greater than or equal to
					 $1 million per DY must report the costs of at least one core activity of its
					 choice, as well as the forecasted or generated savings from that core activity.
(A) The performer must report the costs and
					 savings associated with its selected core activity at the level of the
					 performer's system, to the extent possible.
(B) The performer must submit a progress
					 update on the costs and savings associated with its selected core activity
					 during the second reporting period of DY7.
(C) The performer must submit a final report
					 on the costs and savings associated with its selected core activity during the
					 second reporting period of DY8.
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 354.1711 - Category B Requirements for Performers

Current through Reg. 49, No. 28; July 12, 2024
(a) A performer must provide the following
					 information in the RHP plan update for its RHP to be eligible for its RHP plan
					 update submission funds for DY7 and its Category B valuation for DY7 and DY8:
(1) its total PPP for DY5;
(2) its total PPP for DY6;
(3) its MLIU PPP for DY5; and
(4) its MLIU PPP for DY6.
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 354.1715 - Category D Requirements for Performers

Current through Reg. 49, No. 28; July 12, 2024
(a) There is a Category D - Statewide
					 Reporting Measure Bundle for each provider type, as described in the Measure
					 Bundle Protocol.
(b) Each Category
					 D - Statewide Reporting Measure Bundle consists of one or more measures, as
					 described in the Measure Bundle Protocol.
(c) The valuation for each measure in a
					 performer's Category D - Statewide Reporting Measure Bundle for each DY is
					 equal to the valuation of the performer's Category D - Statewide Reporting
					 Measure Bundle for the DY divided by the number of measures in the Category D -
					 Statewide Reporting Measure Bundle, so that the valuations of the measures are
					 equal.
(d) A performer must report
					 on a measure in the Category D - Statewide Reporting Measure Bundle for its
					 provider type as described in the Measure Bundle Protocol for a DY no later
					 than the second reporting period of the DY to be eligible for payment of the
					 measure for the DY.
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 354.1717 - Uncompensated Care (UC) Hospital Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) An Uncompensated Care (UC) hospital must:
(1) attend at least one learning
					 collaborative, stakeholder forum, or other stakeholder meeting each
					 demonstration year (DY); and
(2)
					 report on the hospital Statewide Reporting Measure Bundle measures required for
					 UC hospitals, as specified in the Measure Bundle Protocol, for each DY.
(A) If a UC hospital fails to report on the
					 hospital Category D - Statewide Reporting Measure Bundle measures required for
					 UC hospitals by the last quarter of the applicable DY, the hospital forfeits
					 one quarter of its UC payments for that DY.
(B) A UC hospital may request from HHSC a
					 six-month extension from the end of the DY to report any outstanding hospital
					 Statewide Reporting Measure Bundle measures required for UC hospitals. The UC
					 hospital will receive the fourth-quarter UC payment only if all outstanding
					 required measures are reported within that six-month extension.
(3) A UC hospital is not eligible
					 to receive DSRIP for Category D - Statewide Reporting Measure Bundle
					 reporting.
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 354.1719 - Disbursement of Funds

Current through Reg. 49, No. 28; July 12, 2024
(a) Basis for
					 payment for the RHP plan update submission. A performer will receive 20 percent
					 of its total DY7 valuation if the anchor of the performer's RHP submits an RHP
					 plan update and HHSC approves the submitted RHP plan update.
(b) Category A and DSRIP payments. If a
					 performer fails to fulfill all of the Category A requirements described in
					 §354.1709 of this division (relating to Category A Requirements for
					 Performers) for a demonstration year (DY), any DSRIP payments the performer
					 received for the DY will be recouped, and prospective DSRIP payments to the
					 performer will be withheld.
(1) DSRIP
					 payments for DY7 include payments for the RHP plan update submission, as well
					 as any payments for DY7 Category B, Category C, or Category D
					 milestones.
(2) DSRIP payments for
					 DY8 include any payments for DY8 Category B, Category C, or Category D
					 milestones.
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 354.1721 - Remaining Funds for Demonstration Years (DYs) 7-8

Current through Reg. 49, No. 28; July 12, 2024
(a) The total remaining funds for DY7 are
					 equal to the DY7 DSRIP pool allocation described in the Program Funding and
					 Mechanics Protocol minus the sum of the DY7 performer valuations described in
					 §354.1707 of this division (relating to Performer Valuations).
(b) The total remaining funds for DY8 are
					 equal to the DY8 DSRIP pool allocation described in the Program Funding and
					 Mechanics Protocol minus the sum of the DY8 performer valuations described in
					 §354.1707 of this division.
(c) The DY7-8 remaining funds are allocated
					 to RHPs as follows:
Attached Graphic
(d) An RHP allocated DY7-8
					 remaining funds may determine how to allocate those funds among the performers
					 in the RHP based on the community needs assessment update. The RHP may allocate
					 these funds to providers that did not participate in DSRIP during the initial
					 demonstration period or DY6 and are eligible to be performers as described in
					 §354.1695 of this division (relating to Participants).
(e) An RHP allocated DY7-8 remaining funds
					 must conduct at least two public stakeholder meetings to determine how its
					 DY7-8 remaining funds allocation will be used.
(f) A performer allocated DY7-8 remaining
					 funds must certify that there is a source of intergovernmental transfers for
					 the funds.
(g) The RHP plan update
					 for an RHP allocated DY7-8 remaining funds must include:
(1) a description of the process used to
					 determine how the RHP's DY7-8 remaining funds allocation will be
					 used;
(2) the performers in the RHP
					 that were allocated DY7-8 remaining funds and the amount of DY7-8 remaining
					 funds allocated to each performer; and
(3) the performers or providers in the RHP
					 that expressed interest in receiving DY7-8 remaining funds but were not
					 allocated any DY7-8 remaining funds.
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 8 - DSRIP PROGRAM DEMONSTRATION YEARS 9-10 › Section 354.1729 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
						division, have the following meanings unless the context clearly indicates
						otherwise.
(1) Core activity--An
					 activity implemented by a performer to improve patient health or quality of
					 care. It may be implemented by a performer to achieve the performer's Category
					 C measure goals or it may be connected to the mission of the performer's
					 organization.
(2) Delivery System
					 Reform Incentive Payment (DSRIP) pool--Funds available to DSRIP performers
					 under the waiver for their efforts to enhance access to health care, the
					 quality of care, and the health of patients and families they serve.
(3) Demonstration Year (DY) 6--Federal fiscal
					 year 2017 (October 1, 2016 - September 30, 2017).
(4) Demonstration Year (DY) 7--Federal fiscal
					 year 2018 (October 1, 2017 - September 30, 2018).
(5) Demonstration Year (DY) 8--Federal fiscal
					 year 2019 (October 1, 2018 - September 30, 2019).
(6) Demonstration Year (DY) 9--Federal fiscal
					 year 2020 (October 1, 2019 - September 30, 2020).
(7) Demonstration Year (DY) 10--Federal
					 fiscal year 2021 (October 1, 2020 - September 30, 2021).
(8) Demonstration Year (DY) 11--Federal
					 fiscal year 2022 (October 1, 2021 - September 30, 2022).
(9) Denominator--As it relates to a Category
					 C measure's volume:
(A) the number of
					 Medicaid and low-income or uninsured (MLIU) cases; or
(B) one of the following, which the performer
					 receives approval from HHSC to use for the measure:
(i) the number of all-payer cases;
(ii) the number of Medicaid cases;
					 or
(iii) the number of low-income
					 or uninsured (LIU) cases.
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 8 - DSRIP PROGRAM DEMONSTRATION YEARS 9-10 › Section 354.1731 - Medicaid and Low-income or Uninsured Patient Population by Provider

Current through Reg. 49, No. 28; July 12, 2024
For the purposes of determining the Medicaid and
						Low-income or Uninsured Patient Population by Provider (PPP):
(1) An individual is classified a Medicaid
					 individual served if the individual was enrolled in Medicaid or the Children's
					 Health Insurance Program at the time of at least one encounter during the
					 applicable DY.
(2) An individual is
					 classified a low-income or uninsured individual (LIU) served if the individual
					 was either at or below 200 percent of the FPL or did not have health insurance
					 at the time of at least one encounter during the applicable DY.
(3) If an individual was enrolled in Medicaid
					 or the Children's Health Insurance Program at the time of one encounter during
					 the applicable DY and was LIU at the time of a separate encounter during the
					 applicable DY, that individual is classified as a Medicaid individual
					 served.
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 8 - DSRIP PROGRAM DEMONSTRATION YEARS 9-10 › Section 354.1733 - Regional Healthcare Partnerships (RHPs)

Current through Reg. 49, No. 28; July 12, 2024
(a) An RHP has geographic boundaries as
					 prescribed by the Health and Human Services Commission (HHSC).
(b) An RHP is composed of one anchor and
					 other participants, which may include intergovernmental transfer (IGT)
					 entities, performers, and other regional stakeholders. A single entity may act
					 in multiple roles.
(c) An IGT
					 entity may participate in more than one RHP contingent upon HHSC
					 approval.
(d) A performer may only
					 participate in the RHP plan update for the RHP in which it is physically
					 located. If a performer has physical locations in more than one RHP, the
					 performer may be assigned to a single "home" RHP of its choosing and
					 participate only in the RHP plan update for its "home" RHP.
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 8 - DSRIP PROGRAM DEMONSTRATION YEARS 9-10 › Section 354.1735 - Participants

Current through Reg. 49, No. 28; July 12, 2024
(a) Anchors.
(1) An anchor must:
(A) serve as the RHP's single point of
					 contact with HHSC, except as specified in rule;
(B) facilitate transparent and inclusive
					 meetings among participants to discuss RHP activities;
(C) coordinate RHP activities to help ensure
					 that participants properly address both the needs of the region and the
					 requirements placed upon the RHP;
(D) coordinate the update of the community
					 needs assessment included in the RHP plan and submit the updated community
					 needs assessment to HHSC, as prescribed by HHSC;
(E) coordinate with the RHP participants to
					 update the RHP plan in accordance with §354.1737 of this division
					 (relating to RHP Plan Update for DY9-10), the Program Funding and Mechanics
					 Protocol, the Measure Bundle Protocol, and all other state or waiver
					 requirements;
(F) hold at least one
					 public meeting before submitting the RHP plan update to HHSC;
(G) submit the RHP plan update to HHSC, as
					 prescribed by HHSC;
(H) post the
					 approved RHP plan update to the RHP website;
(I) develop and submit an annual progress
					 report on behalf of the RHP, in accordance with the Program Funding and
					 Mechanics Protocol and HHSC requirements;
(J) develop and submit a learning
					 collaborative plan, in accordance with the Program Funding and Mechanics
					 Protocol and HHSC requirements;
(K)
					 ensure that all confidential information obtained through its role as an anchor
					 remains confidential as required by state and federal laws and
					 regulations;
(L) ensure that all
					 waiver information provided to it in its capacity as anchor is distributed to
					 the RHP participants; and
(M) meet
					 all other requirements as specified in the Program Funding and Mechanics
					 Protocol.
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 8 - DSRIP PROGRAM DEMONSTRATION YEARS 9-10 › Section 354.1739 - RHP Plan Update Review

Current through Reg. 49, No. 28; July 12, 2024
(a) HHSC
					 reviews and assesses each submitted RHP plan update to determine whether it
					 meets the following criteria:
(1) It is in
					 the prescribed format.
(2) It
					 contains all required elements described in the Program Funding and Mechanics
					 Protocol and the Measure Bundle Protocol and is consistent with the waiver
					 Special Terms and Conditions.
(3)
					 It meets the requirements for Category A - Required Reporting, Category B -
					 MLIU Patient Population by Provider (PPP), Category C - Measure Bundles and
					 Measures, and Category D - Statewide Reporting Measure Bundles, as described in
					 the Program Funding and Mechanics Protocol and the Measure Bundle
					 Protocol.
(4) The funding amount
					 and distribution is in accordance with the Program Funding and Mechanics
					 Protocol.
(5) It is consistent with
					 the goals of the DSRIP program and the objectives of the Medicaid
					 program.
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 8 - DSRIP PROGRAM DEMONSTRATION YEARS 9-10 › Section 354.1741 - RHP Plan Update Modifications

Current through Reg. 49, No. 28; July 12, 2024
A performer may submit a request to HHSC to modify
						elements of the RHP plan update for the performer's RHP prospectively, as
						described in the Program Funding and Mechanics Protocol, including the
						performer's:
(1) System
					 definition;
(2) Category B Medicaid
					 and Low-income Uninsured (MLIU) Patient Population by Provider (PPP);
(3) Category C measure payer types for
					 reporting milestones;
(4) Category
					 C measure payer type for goal achievement milestones;
(5) Category C optional measures if the
					 performer is a hospital or physician practice; or
(6) Category C measures if the performer is
					 a:
(A) community mental health
					 center;
(B) local health
					 department; or
(C) hospital or
					 physician practice that has received approval from HHSC to select measures,
					 rather than Measure Bundles, from the Measure Bundle Protocol as described in
					 §354.1753 of this division (relating to Category C Requirements for
					 Performers).
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 8 - DSRIP PROGRAM DEMONSTRATION YEARS 9-10 › Section 354.1743 - Independent Assessor

Current through Reg. 49, No. 28; July 12, 2024
The independent assessor monitors DSRIP performers for
						compliance with DSRIP program requirements and objectives.
(1) All RHP plan updates are subject to
					 potential audits, including review by the independent assessor, during ongoing
					 compliance monitoring.
(2) Upon
					 request, performers must have available for review by the independent assessor,
					 HHSC, the Centers for Medicare & Medicaid Services, and any other federal
					 entity, all supporting data and back-up documentation demonstrating performance
					 for a milestone as described under an RHP plan update for DSRIP
					 payments.
(3) Failure of a
					 performer to provide supporting documentation demonstrating performance for a
					 milestone in a timely manner may result in recoupment of DSRIP payments or
					 withholding of future DSRIP payments.