Texas Register, Volume 37, Number 34, Pages 6391-6818, August 24, 2012 Page: 6,407
6391-6818 p. ; 28 cm.View a full description of this periodical.
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354.1632. DSRIP Requirements for Regional Healthcare Partner-
ships.
(a) Each Regional Healthcare Partnership (RHP) must select a
minimum number of projects from Categories 1 and 2.
(1) An RHP in Tier 1 must select a minimum of twenty
DSRIP projects from Categories 1 and 2 combined. Of those twenty
DSRIP projects, the RHP must select at least ten projects from Cate-
gory 2.
(2) An RHP in Tier 2 must select a minimum of twelve
DSRIP projects from Categories 1 and 2 combined. Of those twelve
DSRIP projects, the RHP must select at least six projects from Category
2.
(3) An RHP in Tier 3 must select a minimum of eight
DSRIP projects from Categories 1 and 2 combined. Of those eight
DSRIP projects, the RHP must select at least four projects from
Category 2.
(4) An RHP in Tier 4 must select a minimum of four DSRIP
projects from Categories 1 and 2 combined. Of those four DSRIP
projects, the RHP must select at least two project from Category 2.
(b) Two or more performers in the same RHP may not select
the same DSRIP project if the DSRIP projects affect the identical pa-
tient population.
354.1633. DSRIP Requirements for Performers.
(a) For any DSRIP project in Category 1 or 2, a performer must
select at least one process milestone and at least one improvement mile-
stone for the duration of the project, as described in the Program Fund-
ing and Mechanics Protocol (PFM). This subsection does not apply to
the first demonstration year DSRIP project.
(b) A hospital that selects a DSRIP project from Category 1 or
2 must also perform in Categories 3 and 4.
(1) To fulfill its obligations under Category 3, a hospital
must select at least three Category 3 interventions or improvement
milestones from the options listed in the PFM. HHSC, in a manner
consistent with the PFM, may allow a hospital to select only one inter-
vention or improvement milestone from Category 3.
(2) To fulfill its obligations under Category 4, a hospital,
unless exempted by HHSC in accordance with the PFM, must report
on a set of measures identified by the PFM. Required reporting for Po-
tentially Preventable Admissions (PPAs) and Potentially Preventable
Readmissions (PPRs) must begin in the third demonstration year.
Required reporting for Potentially Preventable Complications (PPCs)
must begin in the fourth demonstration year.
(3) If a performer does not have a population for a Cate-
gory 4 measure large enough to produce statistically valid data, that
performer is not required to report the data for that particular Category
4 measure.
(c) A UC hospital must participate in an annual learning col-
laborative 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 Com-
plications (PPCs).
(A) If a hospital fails to report on the three domains by
the last quarter of the applicable demonstration year, the hospital for-
feits UC payments in that quarter.
(B) A hospital may request from HHSC a six-month ex-
tension from the end of the demonstration year to report any outstand-ing 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 re-
ceive DSRIP for Category 4 reporting.
(d) A non-hospital performer is required to select at least one
Category 3 intervention or improvement milestone from those listed in
the RHP Planning Protocol.
(e) A performer may not select a Category 3 intervention for
which the performer has received top performance for at least four con-
secutive quarters prior to December 12, 2011. Top performance for an
intervention is defined by the RHP Planning Protocol.
354.1634. Waiver Pool Allocation and Valuation.
(a) Purpose. In an effort to provide certainty to waiver partici-
pants, HHSC will provide performer specific allocations. This process
requires that certain individual entities receive an allocation based upon
a Regional Healthcare Partnership (RHP) specific allocation.
(b) RHP allocation. All available DSRIP funds are allocated
among the RHPs for each demonstration year. The share of the DSRIP
pool allocated to an RHP will be calculated using the formula: RHP
Share of DSRIP Pool = (200%FPL + %MedicaidAcute + 2011UPL)/3,
where:
(1) "200%FPL" is the region's share of the state's popula-
tion with income below 200% of the federal poverty level as deter-
mined by the 2006-2010 American Community Survey for Texas;
(2) "%MedicaidAcute" is the region's share of all Texas
Medicaid acute care payments in state fiscal year (SFY) 2011. Texas
Medicaid acute care payments consist of the sum of Medicaid fee-for-
service, Medicaid managed care, Vendor Drug Program, and Primary
Care Case Management payments; and
(3) "2011UPL" is the region's share of the state's Medicaid
supplemental payments through the former Upper Payment Limit pro-
gram made to providers in the RHP for SFY 2011.
(c) DSRIP allocation among performers for the first demon-
stration year. Anchors and performers may receive a DSRIP payment
for the first demonstration year after review and approval of the RHP
plan by HHSC.
(1) The anchor is allocated 20% of the RHP allocation for
the first demonstration year. An anchor may also receive a portion of
the allocation in paragraph (2) of this subsection if it independently
qualifies under that paragraph.
(2) The amount of the RHP allocation for the first demon-
stration year not allocated to the anchor as described in paragraph (1)
of this subsection is allocated to performers as follows:
(A) First, divide the value of all of a performer's DSRIP
projects by the total value of all DSRIP projects in an RHP.
(B) Second, multiply the result in subparagraph (A) of
this paragraph by 80% of the RHP allocation for the first demonstration
year for that RHP, or 100% if the anchor is not a Medicaid provider.
The result is the first demonstration year DSRIP to the performer.
(d) Two-pass process for allocating DSRIP. The DSRIP pool
is allocated to performers through a two-stage process.
(1) The first stage (Pass One) sets an initial allocation to
each potential performer, described further in subsection (e) of this sec-
tion.PROPOSED RULES August 24, 2012 37 TexReg 6407
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Texas. Secretary of State. Texas Register, Volume 37, Number 34, Pages 6391-6818, August 24, 2012, periodical, August 24, 2012; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth253226/m1/16/: accessed April 26, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.