RHP9 Updates

Sep

DY8R2 (October) Reporting

The DY8R2 Reporting Webinar will take place on Friday, October 4th from 10 am to 12 pm. Register at https://register.gotowebinar.com/register/7784348112560958220
The October DY8 reporting companion document will be available on the DSRIP Online Reporting System around Monday, 9/30/2019.
The following excel templates are being finalized for the DY8R2 Reporting Period and will be posted to the online reporting system bulletin board:
- Category A Core Activity Reporting
- Category C Reporting Template
- Category C E2-A01 DY8 Milestone Reporting Template
- Category D Reporting Template

Sep

Category A - Costs & Savings

HHSC will provide review criteria for the Costs and Savings portion of Category A in the October DY8 reporting companion document, which will be available around Monday, 9/30/2019.

Sep

Category C

DY8R2 Interim Corrections: HHSC completed review of Category C corrections submitted during the DY8R2 Interim Corrections period and emailed the results to providers and anchors on 9/16. HHSC is in the process of following up with providers with one or more measures flagged for additional TA (technical assistance) through the Interim Corrections process.
Category C Summary Workbook: HHSC will be posting an updated Category C Summary Workbook to the online reporting system early this week. This update will include reported baselines, associated goals, reported PY1 data, and October DY8 reporting eligibility as of 9/18/19. Providers should review the updated Summary Workbook for each of their measures to confirm that the included data is accurate. Providers should email the Waiver mailbox with any issues by noon on Friday, 9/27/19.
TA Update: HHSC has sent an email to each Anchor with outstanding TA Flags in their regions. HHSC is continuing to work with providers to resolve any outstanding baseline/PY1 TA Flags as soon as possible to allow providers to report performance years during October DY8. Providers that have an outstanding baseline TA flag and have not reported PY1 will not be allowed to report PY1 during October DY8, which is the last opportunity to report PY1 and earn the associated RM-2 milestone payments. As of today, there are 22 measures with outstanding baseline TA flags that must work with HHSC ASAP to resolve issues before October DY8 reporting. All providers and anchors have been notified of TA flags that impact October DY8 reporting eligibility.
Goal Calculator Update: HHSC is updating the Goal Calculator to reflect goals approved for DY9-10. HHSC will post an updated Goal Calculator to the online reporting system bulletin board this week.

Sep

Category D

DY8R2 Reporting Eligibility: HHSC will post the file with October DY8 reporting eligibility on the bulletin board early this week.

Sep

Program Funding and Mechanics Protocol and Measure Bundle Protocol

CMS has approved the PFM and MBP! The approved protocols are attached. Additionally, the “Final Provider DY9-10 Valuations and MPTs” and the “Final Related Strategies” Excel files will be posted on the waiver website under “Waiver Renewal” this week.
The major changes in the approved protocols include:

Removal of DY10 carryforward achievement of PY5 (January 1, 2022 - December 31, 2022).
As previously mentioned, based on DSRIP expenditure authority that ends in DY10 (September 30, 2021), CMS has provided guidance on the impact to DSRIP carryforward reporting.

Even though PY4 (January 1, 2021 - December 31, 2021) includes the end of DY10 (September 30, 2021), providers may continue to report PY4 for DY10 Category C achievement (reported in April 2022 or October 2022) and also for DY9 carryforward achievement (reported in April 2022).
However, DY10 carryforward achievement using PY5 (January 1, 2022 - December 31, 2022) is not permissible.
The final DSRIP payments will occur in January 2023 based on October 2022 DY11 reporting.

As previously mentioned, CMS did not agree to HHSC’s proposed increased valuation for Category C reporting milestones of 33% and has required that the same amounts be maintained from DY8 to DY9-10 of 25% of Category C valuation for reporting milestones and 75% of Category C valuation for goal achievement milestones.
Distribution of funds if a provider withdraws from DSRIP: if a performing provider withdraws during the RHP Plan update for DY9-10, the provider’s valuation will be proportionally distributed among the remaining providers in the region. However, if a provider withdraws from participating in DSRIP at any time after the DY9-10 RHP Plan Update, then the funding may not be transferred to other providers in the region. For the provider that closed in RHP 8 and provider that withdrew during the DY8 window in RHP 4, the updated provider valuations that will be posted on the waiver website next week will already reflect the redistribution of those funds among the providers in the region. HHSC is not changing the PFM language paragraph 34 as it has already been approved by CMS and are treating these two providers as having withdrawn through the DY9-10 RHP Plan Update.
Changes to Measure Bundles/measures selections are limited to a maximum deletion of 20 previously selected points with good cause such as a hospital merger, significant change in a required system component, or updated community needs. There is no limit on the number of Measure Bundles/measures that may be added.
All innovative measures, except F1-T03 (Preventative Care & Screening: Oral Cancer Screening), are discontinued from new or continuing selection. F1-T03 is required to be P4P in DY10.
Newly selected measures may not have a baseline numerator of 0 (e.g., no measurable numerator being tracked during the baseline measurement period). For measures previously approved in DY7-8 for a baseline number of 0 and that are continuing in DY9-10, the baseline will be updated to the PY1 (CY2018) rate.

Regarding providers’ request of maintenance for high performance, CMS only approved such maintenance for hospital safety measures (Measure Bundles D3: Pediatric Hospital Safety and J1: Hospital Safety) with perfect performance at baseline, defined as no numerator cases reported during the baseline measurement period with one or more eligible denominator cases. Maintenance of high performance is defined as an increase of one numerator case that was not preventable during a performance year. Each provider eligible for maintenance of high performance may determine a valid definition for a numerator case that is not preventable and will submit documentation to HHSC if reporting maintenance of high performance in a performance year.
D1-237: Well-Child Visits in the First 15 Months of Life was discontinued from Measure Bundle D1: Pediatric Primary Care, resulting in a reduced base point total from 14 points in DY7-8 to 12 points in DY9-10, whether continuing or newly selecting Measure Bundle D1 in DY9-10.
- For DY9-10 base point value totals, please review Table “Hospital & Physician Practice Measure Bundle Menu” (DY7-10 MBP, pg. 22) and Table “D1: Pediatric Primary Care” (DY7-10 MBP, pg. 30)
Related Strategies Lists were added to account for the four new LHD measures (L1-262, L1-263, L1-265, and L1-342).

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