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 4 - DSRIP
Section 354.1633 - DSRIP Requirements for Performers

Universal Citation: 1 TX Admin Code ยง 354.1633

Current through Reg. 49, No. 38; September 20, 2024

(a) For any DSRIP project in Category 1 or 2, a performer must select at least one process milestone and at least one improvement milestone, as described in the Program Funding and Mechanics Protocol (PFM Protocol). This subsection does not apply to the first demonstration year.

(1) Every DSRIP project must include a metric for quantifiable patient impact for the fifth demonstration year.

(2) Every three-year DSRIP project must include a metric for quantifiable patient impact for both the fourth and fifth demonstrations years.

(3) The quantifiable patient impact metric must include a certain level of Medicaid and low-income patients when specified by HHSC and CMS.

(b) A performer that selects a DSRIP project from Category 1 or 2 must also perform in Category 3. A hospital that selects a DSRIP project from Category 1 or Category 2 must also perform in Category 4.

(c) A performer must have at least one [a] Category 3 outcome, selected in accordance with the RHP Planning Protocol, related to each of its Category 1 and Category 2 projects.

(1) A Category 3 outcome must be appropriate for the patient population in the related DSRIP project.

(2) A single Category 3 outcome may relate to more than one Category 1 or Category 2 DSRIP project.

(3) In the third demonstration year, a performer may modify a previously selected, or choose a new, Category 3 outcome based on the revised RHP Planning Protocol.
(A) The RHP Planning Protocol will designate each outcome as either "pay for performance" or "pay for reporting".

(B) In the third demonstration year, each outcome must contain two process milestones. One process milestone must require the performer to provide a status update. The other process milestone must establish a baseline upon which future outcome improvement is measured.

(C) In the fourth and fifth demonstration years, each "pay for performance" outcome must contain one milestone and each "pay for reporting" outcome must contain two milestones.
(i) Every "pay for performance" outcome must contain an achievement target for the fourth and fifth demonstration years.

(ii) The achievement target must be chosen in accordance with the standard target methodology as described in the RHP Planning Protocol.

(iii) A performer may request to set an achievement target different from those described in the standard target methodology. Such a request may only be granted by HHSC if the performer provides a compelling justification.

(iv) Every "pay for reporting" outcome must have an associated alternate improvement activity, which is either a population focused priority measure or a stretch activity, as described in the RHP Planning Protocol.

(D) If performance on a Category 3 "pay for performance" outcome in demonstration year three exceeds the achievement target for the fifth demonstration year, the performer must either increase the achievement target for the fifth demonstration year or add an alternate improvement activity, as described in the RHP Planning Protocol.

(E) A performer must report progress on improving Category 3 outcomes in the fourth and fifth demonstration years.

(d) To fulfill its obligations under Category 4, a hospital, unless exempted by HHSC in accordance with the PFM Protocol, must report on a set of required domains.

(1) Potentially Preventable Admissions (PPAs), Potentially Preventable Readmissions (PPRs), Potentially Preventable Complications (PPCs), Emergency Department (ED), and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) are all required domains.

(2) Reporting for all required domains, except PPCs, must begin in the third demonstration year. Reporting for PPCs must begin in the fourth demonstration year.

(3) If a performer does not have a population for a Category 4 measure large enough to produce statistically valid data as described in the RHP Planning Protocol, that performer is not required to report the data for that particular Category 4 measure.

(4) A performer may choose to report on the additional optional domain described in the RHP Planning Protocol.

(e) A UC hospital must participate in an annual learning collaborative and report on a subset of Category 4 measures.

(1) The required subset of Category 4 measures consists of three domains: Potentially Preventable Admissions (PPAs), Potentially Preventable Readmissions (PPRs), and Potentially Preventable Complications (PPCs).
(A) If a hospital fails to report on the three domains by the last quarter of the applicable demonstration year, the hospital forfeits one quarter of its UC payments for that demonstration year.

(B) A hospital may request from HHSC a six-month extension from the end of the demonstration year to report any outstanding Category 4 measures. The hospital will receive the fourth-quarter UC payment only if all outstanding required Category 4 measures are reported within that six-month extension.

(2) A hospital under this subsection is not eligible to receive DSRIP for Category 4 reporting.

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