Good afternoon Region 2,
Please see the two attached documents [TexasTransitionYear_PFM_060816.pdf and Additional Operational Details for Cat 3 in DY6.docx] received from HHSC regarding the DY6 transition year. Please note that HHSC is asking for feedback by Friday, June 17th.
New information that is of special note within the PDF file:
- On page 2: the introduction of DY6A and DY6B to represent the 15-month transition year. From an operational (metric) standpoint, HHSC plans to consider DY6B as DY7 metrics, but the details behind those deliverables are still to be determined.
- On page 4: Category 4 funding, for those currently participating, will remain the same UNLESS it represents more than 10% of your DSRIP valuation. If it does represent more than 10%, for DY6A it will be capped at 10% and the overage will be reallocated evenly across all of your Category 3s.
- On page 7: a new inclusion to the projects eligible for a DY6 MLIU QPI goal adjustment; the language added is vague (“any other DSRIP project that HHSC determines has a strong justification for an adjustment”).
- On page 8:
- Added language to account for providers who did not document health insurance coverage or financial status prior to the start of DY5.
- Added the potential of a Project Level Evaluation under possible activities for DY6A Category 1/2 Sustainability Planning (non-QPI) metrics.
- Refined language around DY6 Category 3. Please also see the attached Word file for additional information on the option to adjust the 12-month timeframe used for reporting when reporting the DY6 (PY3) achievement.
- On page 9: continuation of Category 3. Please note that:
- The new language for those projects with DY5 Stretch Activities or Maintenance metric requirements.
- HHSC plans to issue either a revised file or a calculation template for determining the new DY6 (PY3) targets, including clarification for those projects where baseline fell below the minimum performance level.
- The updated language on PY3 achievement calculations, which will be based off PY1 goal rather than Baseline.
- On page 10:
- For those Category 4 participating organizations that are reporting RD6, that will be removed in DY6. Funds associated with RD6 will be evenly spread across RDs 1-5.
- Confirms that UC only hospitals will again participate in at least one learning collaborative event in DY6.
- On page 12: MSLC reviews will continue.
You will also see on page 12 information regarding DY6 learning collaborative planning, community needs and stakeholder engagement. All of this will be discussed further at our upcoming Regional meeting, which will be on the campus of UTMB in Galveston on Friday, July 8th. If you have not already done so, please RSVP to Bobbie Guyton (email@example.com) by COB on Wednesday, June 29th so that we can assure that we have our room configured correctly and have an accurate headcount for catering. The meeting is scheduled to run from 9:30 am-1:15 pm (lunch provided), with optional breakout sessions and a tour of the new Jennie Sealy Hospital building available in the afternoon.
Craig S. Kovacevich, MA
Associate Vice President,
Waiver Operations &
Community Health Plans
1115 Medicaid Waiver – RHP 2
UTMB HealthCare Systems
UTMB Community Health Plans
Thanks very much for your flexibility to have the call today. Please let us know by 3 pm next Friday, June 17, if there are any major concerns about the PFM.
Attached are some additional details on Category 3. The rules are in the final stages and we will also provide the information that will be in the rules as soon as we can (this is the 2nd set of rules).
We will have a timeline in the next Anchor call for next steps. You are welcome to send questions related to implementation to the waiver mailbox.
We mentioned a Category 3 partial payment issue related to reporting on the call. The payment calculations for the first reporting period for DY 5 are in progress. We wanted to make you aware that Category 3 partial payment calculations that impact a small number of providers will be adjusted based on some conflicting information in the RHP Planning Protocol and subsequent implementation strategy. The providers that this impacts will be notified and this only affects providers in a positive, not negative manner, with their payments. Going forward, the partial achievement calculation for AM-2.x milestones will measure partial achievement over the approved baseline. This will increase the percent of goal achieved in DY5 for some providers reporting partial achievement of their AM-2.x goal. We’ll be updating the April DY5 reporting companion and the Category 3 Summary Workbook & Goal Calculator in the coming weeks to reflect this change.
Thank you for your continued work that benefits the health care of Texans.
Texas Health and Human Services Commission
Deputy Medicaid CHIP Director, Healthcare Transformation Waiver
From: HHSC Texas Healthcare Transformation and Quality Improvement Program
Based on our call with CMS today, we will plan to have the anchor call Thursday at 1:30 as scheduled. In advance of the call, we are attaching the proposed Program Funding and Mechanics Protocol (PFM) for DY6, which CMS has indicated they are amendable to. Most of the elements in this PFM are the same as the proposal previously posted on the waiver website and shared with you, and also includes some changes to Cat 3 and removal of the performance bonus pool previously discussed with anchors. We will plan to discuss this proposal on the call tomorrow, including any changes from the version you have already seen.
In lieu of sending out Anchor Notes this week, please find additional important information below:
Updated MPL for IT-12.2 Cervical Cancer Screening
- HHSC has identified that the Minimum Performance Level for IT-12.2 Cervical Cancer Screening was incorrectly seeded into the Category 3 reporting companion. The MPL has been changed from .6837 to .6137. For most providers, this results in a lowered goals in DY4 and DY5. We’ve updated our internal database with the corrected MPL and adjusted DY4 and DY5 goals for impacted providers.
Category 3 DY5 R2 Interim Corrections
- HHSC will have another Category 3 Interim Correction period this summer. Currently, we anticipate an interim correction period template being released the end of June, with a target due date back to HHSC of July 20th.
- As a reminder the interim correction period is intended for making corrections to:
– P4P outcomes that have previously reported performance
– Outcomes that have a custom goal
– P4P outcomes that have not been reviewed by MSLC.
- The DY5 R2 interim correction period will allow corrections to previously reported and approved baseline, PY1, PY2, and PY3 due to errors in measure interpretation or data collection. The October DY5 Category 3 reporting template will still allow corrections to prior reporting for P4R outcomes and P4P outcomes that have not yet reported performance and do not have a custom goal. The interim correction period is not intended for outcomes that need to make corrections to DY5 R1 reporting due to a “Needs More Information” determination.
Updated Category 3 Summary Workbook
- HHSC will be releasing an updated Category 3 Summary Workbook & Goal Calculator prior to the interim correction period. This update will include DY5 R1 reporting.
New Baselines and Baseline Corrections submitted in the April DY5 Reporting Template
- HHSC will be reviewing baselines newly reported or corrected through the April DY5 reporting template in June and contacting providers individually if any follow up TA is needed. HHSC hopes to have this review complete by mid-July.
Statewide Learning Collaborative
- Just a reminder that registration for providers and anchors for the SLC is open. We have gotten some inquiries from providers, and we are directing them to contact their anchor to coordinate registration.
- We have received a few templates nominating projects to highlight at the SLC. We’d like as many as possible to consider, so please let us know if you need additional time. We are hoping to finalize the agenda soon so we can get it out to participants sooner than in prior years.
- As in years past, we would like to showcase DSRIP success stories that represent the breadth and depth of projects across the state. This year, we would particularly like to highlight the specific impact on the uninsured population and on those in the Medicaid program. This could also include projects that impact both Medicaid and uninsured with explanations of the benefits for both. Given where we are with the waiver extension and ongoing negotiations over a new five-year waiver, we believe that focusing on outcomes specifically for these two populations will be most beneficial.
- We would like your help in gathering information from hospitals and other providers in your RHPs. Specifically, we would like:
- Video submissions focusing on DSRIP outcomes. These video stories should be no more than 2 minutes. We prefer not to have patient narrative stories. Videos should discuss a particular DSRIP project and its impact on the uninsured and/or Medicaid enrollees.
- For hospitals and other providers that do not have the capability of submitting a video, the other option is to submit two PowerPoint slides. The first slide should give a brief project description and the second slide should detail outcomes for the uninsured and/or those in the Medicaid program.
- Thank you in advance for your assistance in reaching out to your RHP providers and in making the learning collaborative a success!
Healthcare Transformation Waiver Operations
Texas Health and Human Services Commission