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 354.1636 - Payment for DSRIP Performance

Universal Citation: 1 TX Admin Code ยง 354.1636

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

Payment for DSRIP project performance is based on achievement of a milestone bundle, outcome, or domain.

(1) A milestone bundle is the compilation of milestones and related metrics associated with a project in a given demonstration year.

(2) The amount of the DSRIP to the performer is determined by the value assigned for the DSRIP project for that demonstration year and the progress made within the milestone bundle.

(3) To calculate the payment for Categories 1 and 2:

(A) First, a performer must fully achieve a metric to include that metric in the DSRIP payment calculation.

(B) Second, a milestone is assigned an achievement value of:
(i) 1.0 if all metrics are met;

(ii) 0.75 if at least 75% of the metrics are met;

(iii) 0.5 if at least 50% of the metrics are met;

(iv) 0.25 if at least 25% of the metrics are met; and

(v) zero if less than 25% of the metrics are met.

(C) Third, the achievement values for each milestone are summed.

(D) Fourth, the result of subparagraph (C) of this paragraph is divided by the total possible achievement value of the milestone bundle.

(E) Fifth, the value of the DSRIP project for that demonstration year, as determined under §354.1635(a) of this division (relating to DSRIP Project Valuation), is multiplied by the result of subparagraph (D) of this paragraph.

(4) Eligibility for payment for Category 4 performance is based on the following:

(A) For a payment of up to 5% of its allocation for the second demonstration year, a performer must submit a status report to HHSC that describes system changes put in place to prepare for Category 4 reporting for the duration of the waiver.

(B) For a payment for a domain in the third, fourth, or fifth demonstration years, a performer must report on all Category 4 measures included in the domain as described in the RHP Planning Protocol.

(5) A performer may assign different values to Category 3 outcome milestones for the second demonstration year, but for the third through fifth demonstration year all milestones for an outcome will be valued equally each year, including both process milestones and achievement milestones.

(A) A performer must fully achieve metrics associated with process milestones to receive DSRIP related to those milestones.

(B) To calculate a payment for an achievement milestone:
(i) First, an achievement milestone is assigned an achievement value of:
(I) 1.0 if the achievement target is achieved;

(II) 0.75 if the achievement target is at least 75% achieved;

(III) 0.5 if the achievement target is at least 50% achieved;

(IV) 0.25 if the achievement target is at least 25% achieved; or

(V) zero if achievement target is less than 25% achieved.

(ii) Second, the result in clause (i) of this subparagraph is multiplied by the value listed in the RHP plan for that particular achievement milestone.

(6) If a performer does not complete all milestones as specified in its RHP plan for a particular demonstration year, the performer may carry forward the available DSRIP funding associated with that milestone bundle until the end of the following demonstration year.

(A) The performer must complete the remaining milestones during the following demonstration year to receive full payment for those milestones.

(B) A performer must provide a narrative description on the status of the missed milestones and outcome improvement targets and outline the performer's plan to achieve the missed milestones or targets by the end of the following demonstration year.

(C) This provision does not apply to Category 4.

(7) If a performer does not complete the remaining milestones as described in paragraph (6) of this section or the Category 4 reporting in its particular year, the associated DSRIP funding is forfeited.

(8) At no point may a performer receive a DSRIP payment for a milestone more than two years after the end of the demonstration year in which the milestone is to be completed according to the RHP plan.

(9) Once the action associated with a metric is reported by the performer as complete that metric may not be counted again toward DSRIP payment calculations.

(10) For any DSRIP payment cycle, an IGT entity change request must be submitted to HHSC no later than the last day of the associated DSRIP reporting period.

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