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 5 - ACTIONS IN PREPARATION FOR EXTENSION OF THE DSRIP PROGRAM
Section 354.1649 - Certain Requirements for the Planned Transition Year and their Exceptions

Universal Citation: 1 TX Admin Code § 354.1649

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

(a) To be eligible for the MLIU QPI milestone payment, beginning in the transition year, performers must report for each DSRIP project the MLIU individuals served or encounters provided at the individual or encounter level as opposed to the percentage of total QPI.

(b) There are limited exceptions to this requirement. Performers may request an exception to this requirement by a date to be determined by HHSC. DSRIP projects eligible for an exception include:

(1) a DSRIP project for which the performer did not assess the DSRIP project participants' health insurance coverage or financial status prior to September 30, 2015, and instead used a proxy to estimate the MLIU population served in their October DY4 QPI Reporting Template, and:

(A) utilizes an intervention site that is a school, non-medical social service office (i.e., shelter), or community health fair;

(B) is in Project Area 1.6 (Enhance Urgent Medical Advice), 2.6 (Implement Evidence-based Health Promotion), or 2.7 (Implement Evidence-based Disease Prevention Programs); or

(C) the performer is a Local Health Department that does not bill Medicaid for the types of services provided through the DSRIP project; or

(2) any other DSRIP project that HHSC determines has a strong justification for an exception.

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