RHP9 Updates

• A Costs and Savings Frequently Asked Questions (FAQ) document is attached.  It has also been posted to the DSRIP Online System Bulletin Board. 
• Please review this FAQ document before submitting questions to HHSC regarding the Costs and Savings portion of Category A. 

• HHSC has received questions from providers about how long they need to retain data associated with DSRIP, especially related to DY2-6 projects. 
• HHSC recommends that providers follow the same data retention policies as they do for their Medicaid services. 
• The Texas Medicaid Provider Procedures Manual requires all Medicaid providers to retain related documents and claims for a "minimum period of five years from the date of service or until all audit questions, appeal hearings, investigations, or court cases are resolved." However, freestanding RHCs must retain their records for a minimum of six years, and hospital-based RHCs must retain their records for a minimum of ten years.

• FAQs related to Cost and Savings will be posted to the Bulletin Board soon. Will send once posted. 
• Attached are the Costs & Savings Guide.  This was sent to providers in the my email on 8/23.  There are no updates to this document. 

            Costs-Savings Guidance DY7-8 8 20

• For measures marked as “Flagged for TA” from early baseline review, HHSC will send a written summary of issues identified in the baseline review to providers via email by the end of September.  RHP9 emails started going out on Friday, from HHSC. 
  • Depending on the identified issues, HHSC may request a response in writing or request a conference call.
  • Some of the changes that could result from TA include:
    • Changes to the milestone structure, baseline measurement period, approved approximate baseline, or baseline numerator of zero;
    • Requiring that a correction be submitted in October DY7 or prior to PY1 reporting.

       

• HHSC will be posting updated Category C specifications and Category C Specifications FAQ to the online reporting system bulletin when it is back online. Updates to the specifications are listed below:
  • G1-278 Beliefs and Values - Percentage of hospice patients with documentation in the clinical record of a discussion of spiritual/religious concerns or documentation that the patient/caregiver did not want to discuss: Change Additional Information from "Step 1- Identify all patients with serious, life-limiting illness who were discharged from hospice care during the designated reporting period" to "Step 1- Identify all patients with serious, life-limiting illness who qualify for the denominator during the measurement period" to remove requirement for a discharge during the measurement year. Remove sentence from Numerator Inclusion: "The denominator/numerator data is collected within 1 to 12 months following discharge from hospice services."
  • B1-141 Risk Adjusted All-Cause 30-Day Readmission for Targeted Conditions: heart failure hospitalization, coronary artery bypass graft (CABG) surgery, CHF, Diabetes, AMI, Stroke, COPD, Behavioral Health, Substance Use: Clarify that numerator and denominator are the actual to expected ratio for targeted condition only (actual number of readmissions following targeted admission out all targeted admissions).
  • C1-105, F1-105, K1-105, L1-105, M1-105 Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention: Added DSRIP Specific Modification to clarify that only one rate is being reported for EHR. Providers should include all eligible individuals in the reported denominator. The numerator would include individuals who were screened for tobacco use, and if identified as a user, received tobacco cessation intervention. This will align the EHR specifications with the current claims specifications.
  • K2-355 Admit Decision Time to ED Departure Time for Admitted Patients: Clarify that providers will report the MLIU median all-payer Medicaid, rather than the Medicaid and LIU median.
  • J1-221 Patient Fall Rate: Remove the X1000 multiplier from denominator
  • C2-106 Cervical Cancer Screening: Remove requirement that self-reported labs are not allowed as communicated in the Category C Specs FAQ.
  • D3-330 Pediatric CLABSI: Clarified that for DSRIP reporting purposes, only one rate is reported (Number of CLABSIs per 1000 central line days (Numerator/Denominator))

     

• HHSC has posted PPR norms for All-Payer data of CY2016 and for Medicaid+CHIP data of CY2017 as a resource to providers on the DSRIP online reporting system. Providers may elect to utilize the updated normative values for risk-adjusting measures, if appropriate. HHSC asks that if a provider utilizes the updated norms for baseline reporting that they continue to use those for performance year reporting.

Attached are the Cat D questions that will be in the Cat D reporting template for October DY7.  

Category D Reporting Questions