Mar 07

RHP 2- 3/2/18 Anchor Update

Good afternoon Region 2,

Please see the HHSC email below – the Online Reporting System appears to be back online after its maintenance. As of yet, the updated Category B FAQ has not been released.

For LHDs and CMHCs, please see the section on follow-up from the Anchor Call of 2/27. HHSC has said that if an organization wants to drop a measure after the regional plan has been approved but before baseline data has been submitted, a replacement measure of greater or equal point value must be selected (i.e., if your MPT is 24 and you submit your plan with 30 points selected, if the decision is made to drop a 2 point measure your organization would have to replace it despite the fact that at 28 points this would still exceed the MPT).

The Anchor office has updated the webpage to provide you access to the updated Community Needs Assessment ( – this should support you in the development of your template for the regional plan submission. As a reminder, RHP 2 plans to host a Regional Meeting in Galveston on March 28th from 1:00-4:00; it is the intent to review the full regional plan submission at that time. To facilitate the completion of the full Regional Plan, please note that the Anchor office requests that you return your completed provider workbook to by COB on Friday, March 9, 2018.

• To support our Regional Performing Providers, the Anchor team is available for technical assistance. If you would like to request an appointment, please utilize the following link – we will work to ensure that our office confirms your request ASAP.

Susan Seidensticker, BSIE, MSHAI, CPHQ, CSSBB, PMP
Director, Waiver Quality Operations
University of Texas Medical Branch (UTMB)
Shearn Moody, 9th Floor

From: HHSC Texas Healthcare Transformation and Quality Improvement Program []
Subject: 3/2/18 Anchor Update

A few updates for you this week. We will update the Category B and C FAQs next week with any new or additional information from the call and this email.

DSRIP Online Reporting System
• The DSRIP Online Reporting System will be taken down for maintenance from the evening of Thursday, March 1st, through Sunday, March 4th. Users will NOT be able to access the reporting system during this time.

Follow-up on Questions from 2/27 Anchor Call:
• Question: Can a CMHC measure be deleted and not replaced if the provider selected more than one of M1-165, M1-181 and/or M1-268, since the value of that measure to the provider is zero?
Answer: If the CMHC selected more than one of those measures and wants to drop one, they will have to replace the measure with a measure of any point value, as long as one of the measures M1-165, M1-181 and/or M1-268 is kept.
If selected all 3 measures and:
• Remove 1 measure, then replace with at least 1 measure of any point value
• Remove 2 measures, then replace with at least 1 measure of any point value
• Remove 3 measures, then replace with at least 4 points worth of measures
If selected 2 measures and:
• Remove 1 measure, then replace with at least 1 measure of any point value
• Remove 2 measures, then replace with at least 4 points worth of measures

• Question: Can providers align Category C LIU payer type with their PPP LIU definition?
Answer: No, if an individual has insurance at the end of the measurement period, they may not be counted as uninsured for Category C LIU payer type purposes even if they were uninsured earlier in the measurement period. An individual should be uninsured at the end of the measurement period to qualify as uninsured for Category C.

• Question: Is HHSC requiring the encounters for the attributed population inclusion occur on separate days or just allowing for that possibility? The most recent Cat C FAQ says encounters “may” be on separate days, but during the last webinar, HHSC said the encounters “should” be on different days. This makes a difference for our attributed population and clarification is requested.
Answer: We agree that our guidance has been confusing. The encounters may occur on the same day but should be separate encounters. The provider may also count encounters that occur on separate days. It can be up to the provider to determine if they want to count separate encounters (for different services) on the same day or only encounters on different days.

• We have received a lot of questions about J1-220 Surgical site infections (SSI) rates. HHSC reviewed the Patient Safety Component manual that was published on January 2018. The staff believes that many of the questions that have been asked about this measure will be answered if HHSC uses that manual for measure specifications instead of measure specifications for NQF 0299. We are reaching to Clinical Champions to request their opinion on the use of the Patient Safety Component manual for purposes of measure specifications. Some providers recommended to use NQF 0753 instead of NQF 0299, however, it does not seem to be fully comparable since it is applied to two operative procedures only. We will provide further communication once we receive feedback from the Clinical Champions.

• Overall, HHSC wants to emphasize that providers should ensure that the measures they are selecting in the RHP Plan Update submission are their final choices. Changes after plan submission and before final approval should only be made based on HHSC feedback (e.g., delayed baseline is not approved, use of an all-payer denominator for achievement is denied, or provider’s Category C valuation distribution justification is not accepted).

Category B
• Anchors requested a clarification about which outpatient clinics are considered required and which ones are optional. HHSC created a draft list of possible required and optional clinics, however, this list is not all inclusive. Providers would need to use their judgement if some areas are not reflected on this list or consult HHSC. HHSC welcomes anchor’s feedback on this list. If possible please provide feedback by end of the day, Monday, March 5th. HHSC would like to include a list of required and optional clinics in the updated version of FAQ, which will be made available on March 6th.

Required Clinics, owned or operated by the provider have to be included if the provider has these clinics: Optional – provider may choose to include those but not required
Primary care clinics;
Specialty care clinics;
Outpatient cancer centers;
Surgery centers;
Outpatient therapy centers (physician or occupational therapy, speech)
Other rehab centers, such as drug or alcohol rehabilitation centers;
Cardiac catheterization centers;
Gastrointestinal centers (may provide screening or other services such as colonoscopy and endoscopy);
Chemotherapy and radiation therapy centers
Contracted primary or specialty care clinics;
School-based clinics;
Imaging and diagnostic centers (e.g. X-ray and ultrasound; labs and MRI);
Dialysis centers;
Diagnostic centers, such as labs and MRI scans;
Wound care centers;
Pain management centers;
Cosmetic centers;
Sleep Centers;
Durable medical equipment rental facilities.

• HHSC is updating the Category B FAQ with previous responses that were shared with the anchors. HHSC will also issue additional guidance in the Category B FAQ related to owned and operated facilities.

Hospitals and Physician Practices with a Limited Scope of Practice
• The deadline for hospitals and physician practices with a limited scope of practice to request a reduced minimum point threshold (MPT) is today, Friday, March 2.
• Hospitals or physician practices with a limited scope of practice may include children’s hospitals and specialty hospitals such as infectious disease hospitals, cancer centers, and Institutions for Mental Disease (IMDs). Rural hospitals are not considered to have a limited scope of practice.
• To request a reduced MPT, a hospital or physician practice with a limited scope of practice should do the following:
1. Send an email to the Transformation Waiver mailbox at (with a cc: to their RHP’s anchor) that lists the:
a. Organization name
b. TPI
c. RHP
d. Designated contact name and phone number
e. The Measure Bundles on which the provider believes they can reasonably report
2. Include as the subject line of the e-mail: “Limited Scope of Practice – Request for Reduced MPT”
• HHSC will then review the submitted Measure Bundles and send follow up questions and/ or schedule a phone call to discuss. The discussion will include the possibility of adding measures outside of the Measure Bundle structure.

Health Information Exchange (HIE)
• The Office of eHealth Coordination (OeHC) at HHSC coordinates with federal and state partners, including the Texas Health Services Authority (THSA), on the development of statewide end-to-end connectivity opportunities. At this time, HHSC does not have any funds specifically for healthcare providers to connect with local HIEs; however, incentive funds received through DSRIP could be used to support HIE connectivity.
• The interim director of OeHC at HHSC is Hope Morgan. She is available to meet with RHPs for discussions about HIE connectivity and what that potentially could mean for the healthcare providers in your RHP. If you would like more information about this or would like Ms. Morgan to attend one of your regional meetings, please feel free to contact her at

Please let us know if you have any questions. Have a great weekend! Thanks,

Amanda Broden
Healthcare Transformation Waiver Operations
Medicaid/CHIP | 512-438-2295*
*Please note new office phone number

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