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 354.1635 - DSRIP Project Valuation
Universal Citation: 1 TX Admin Code ยง 354.1635
Current through Reg. 49, No. 38; September 20, 2024
(a) Each individual DSRIP project and domain must include a rational monetary value. That value is determined by the performer within the strictures described in this subsection and the PFM Protocol.
(1)
Except as described in paragraph (2) of this subsection, a hospital performer
must ensure that project values comport with the following funding
distribution:
(2) A
hospital that is exempted from Category 4 reporting may allocate the Category 4
funding to Categories 1, 2, or 3.
(3) A non-hospital performer must ensure that
the project values comport with the following funding distribution:
(4) A
Category 1 or 2 DSRIP project may be valued at no more than the greater of 10%
of a performer's Pass One allocation or $20 million in total for demonstration
years two through five. For DSRIP projects conducted under the collaboration
options, the project may be valued at no more that the greater of the sum of
10% of each collaborator's Pass One allocation or $20 million in total for
demonstration years two through five. For three-year DSRIP projects, the total
value for any pair of Category 1 and 3 or Category 2 and 3 projects may be no
more than $20 million for demonstration years three through five.
(5) Milestones for a Category 1 or 2 DSRIP
project must be valued equally within a demonstration year.
(b) All Category 3 milestones within a demonstration year must be valued equally beginning with the third demonstration year. Category 3 valuation is determined as follows:
(1) A performer must assign a minimum
percentage of the sum of the funds originally assigned to all Category 3
outcomes in the first approved RHP plan to the Category 3 outcomes associated
with each Category 1 and 2 project.
(2) The minimum percentage is determined
through the formula: minimum percentage = avg% x .5, where "avg%" is the total
number of the performer's Category 1 and 2 DSRIP projects divided by
100.
(3) HHSC may grant an
exception to the minimum percentage requirement if such an exception is
necessary for the performer to retain proportional valuation between Category 3
outcomes and the related Category 1 and 2 DSRIP projects.
(4) Once the performer determines the
percentage of its available Category 3 funding to assign to the Category 3
outcomes associated with a Category 1 or 2 DSRIP project, HHSC will allocate an
equal amount of Category 3 funds to each outcome, and also to each milestone
for that outcome in a given demonstration year.
(5) Category 3 funding must be split among
"pay for reporting" and "pay for performance" milestones as follows:
(c) For the third, fourth, and fifth demonstration years, a performer may allocate an added 5% of funding to Category 4 only when the performer reports on the optional domain as it is described in the RHP Planning Protocol.
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