Current through Reg. 49, No. 38; September 20, 2024
(a) Basis for
payment for the RHP plan update submission. A performer will receive 20 percent
of its total DY7 valuation if the anchor of the performer's RHP submits an RHP
plan update and HHSC approves the submitted RHP plan update.
(b) Category A and DSRIP payments. If a
performer fails to fulfill all of the Category A requirements described in
§354.1709 of this division (relating to Category A Requirements for
Performers) for a demonstration year (DY), any DSRIP payments the performer
received for the DY will be recouped, and prospective DSRIP payments to the
performer will be withheld.
(1) DSRIP
payments for DY7 include payments for the RHP plan update submission, as well
as any payments for DY7 Category B, Category C, or Category D
milestones.
(2) DSRIP payments for
DY8 include any payments for DY8 Category B, Category C, or Category D
milestones.
(c) Basis
for payment of Category B. A performer's payment for its MLIU PPP milestone for
a DY is calculated as follows.
(1) If the
performer's MLIU PPP goal achievement is greater than or equal to 100 percent
minus its allowable MLIU PPP goal variation, the performer's MLIU PPP milestone
payment is equal to 100 percent of its MLIU PPP milestone valuation.
(2) If the performer's MLIU PPP goal
achievement is greater than or equal to 90 percent, and less than 100 percent
minus its allowable MLIU PPP goal variation, the performer's MLIU PPP milestone
payment is equal to 90 percent of its MLIU PPP milestone valuation.
(3) If the performer's MLIU PPP goal
achievement is greater than or equal to 75 percent, and less than 90 percent,
the performer's MLIU PPP milestone payment is equal to 75 percent of its MLIU
PPP milestone valuation.
(4) If the
performer's MLIU PPP goal achievement is greater than or equal to 50 percent,
and less than 75 percent, the performer's MLIU PPP milestone payment is equal
to 50 percent of its MLIU PPP milestone valuation.
(5) If the performer's MLIU PPP goal
achievement is less than 50 percent, the performer does not receive a MLIU PPP
milestone payment.
(d)
Basis for payment of Category C.
(1) Reporting
milestones. A performer must fully achieve a reporting milestone to be eligible
for payment related to the milestone.
(2) P4P measure goal achievement milestones.
A P4P measure has a goal achievement milestone for each DY. With the exception
of P4P measure goal achievement milestones described in subparagraph (B) of
this paragraph, partial payment for P4P measure goal achievement milestones is
available in quartiles for partial achievement measured over baseline in
Performance Year (PY) 1, PY2, and PY3.
(A) To
calculate the payment for a P4P measure goal achievement milestone, multiply
the milestone valuation by the achievement value calculated in clause (ii) of
this subparagraph.
(i) The percent of the
milestone's goal achieved by the performer is determined as follows.
(I) Measures with a positive directionality
where higher scores indicate improvement:
(-a-) DY7 achievement = (PY1 Achieved -
Baseline/ (DY Goal - Baseline).
(-b-) Carryforward of DY7 achievement = (PY2
Achieved - Baseline)/ (DY7 Goal - Baseline).
(-c-) DY8 achievement = (PY2 Achieved -
Baseline)/ (DY8 Goal - Baseline).
(-d-) Carryforward of DY8 achievement = (PY3
Achieved - Baseline)/ (DY8 Goal - Baseline).
(II) Measures with a negative directionality
where lower scores indicate improvement:
(-a-) DY7 achievement = (Baseline - PY1
Achieved)/ (Baseline - DY7 Goal).
(-b-) Carryforward of DY7 achievement =
(Baseline - PY2 Achieved)/ (Baseline - DY7 Goal).
(-c-) DY8 achievement = (Baseline - PY2
Achieved)/ (Baseline - DY8 Goal).
(-d-) Carryforward of DY8 achievement =
(Baseline - PY3 Achieved)/ (Baseline - DY8 Goal).
(ii) The achievement value is
determined as follows.
(I) If 100 percent of
the goal is achieved, the achievement value is 1.0.
(II) If less than 100 percent but at least 75
percent of the goal is achieved, the achievement value is 0.75.
(III) If less than 75 percent but at least 50
percent of the goal is achieved, the achievement value is 0.5.
(IV) If less than 50 percent but at least 25
percent of the goal is achieved, the achievement value is 0.25.
(V) If less than 25 percent of the goal is
achieved, the achievement value is 0.
(B) If a P4P measure designated as Quality
Improvement System for Managed Care has a baseline above the High Performance
Level, the performer must achieve 100 percent of the goal achievement milestone
to be eligible for payment of the milestone; there is no payment for partial
achievement.
(e) Basis for payment of Category D. A
performer must report on a measure in the Category D - Statewide Reporting
Measure Bundle for its provider type for a DY in accordance with
§354.1715(d) of this division (relating to Category D Requirements for
Performers) to be eligible for payment of the measure for that DY.
(f) At no point may a performer receive a
DSRIP payment for a milestone more than two years after the end of the DY in
which the milestone is to be completed.
(g) If a performer does not complete the
remaining milestones as described in §RSA
354.1711 of this division (relating to
Category B Requirements for Performers) or §RSA
354.1713 of this division (relating to
Category C Requirements for Performers), or the Category D - Statewide
Reporting Measure Bundle measures as described in subsection (e) of this
section, the associated DSRIP funding is forfeited by the performer.
(h) Once the action associated with a
milestone is reported by the performer as complete, that milestone may not be
counted again toward DSRIP payment calculations.
