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 354.1753 - 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 DY9-10 for its RHP.
(B)
					 Each Measure Bundle is assigned a point value for DY9-10 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 DY9 and DY10. If a hospital or
					 physician practice does not select Measure Bundles 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 Measure Bundles it selects.
(E) A hospital or physician practice may
					 request to delete a maximum of 20 points worth of its DY7-8 Measure Bundles and
					 measures for DY9-10 with good cause. In this context, good cause is defined as:
(i) a significant system change, such as a
					 hospital merger;
(ii) updated
					 community needs; or
(iii) a
					 significant change in a Measure Bundle's required system component of
					 outpatient services or hospital services as described in the Measure Bundle
					 Protocol.
(F) 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.
(G) A hospital or physician practice with a
					 valuation greater than $2,500,000 per demonstration year (DY) for DY7-8 or with
					 a valuation greater than $2,000,000 in DY10 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.
(H) A hospital or physician
					 practice with an MPT of 75 must report at least two population-based clinical
					 outcome measures as P4P as specified in the Measure Bundle Protocol.
(I) 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.
(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
					 for DY9-10 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 following
					 requirements apply:
(i) the hospital's or
					 physician practice's total valuation for DY9 and DY10 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 DY9 and DY10. If the hospital or physician practice 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.