Current through Reg. 49, No. 38; September 20, 2024
(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 activities.
(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 §
RSA
354.1633 of this subchapter (relating to
DSRIP Requirements for Performers); and
(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.
