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1115 Waiver

The 1115 Waiver fundamentally shifted how healthcare providers collaborate and develop healthcare infrastructure. Still, the rules and guidance frequently change. Below are resources from HHSC and CMS. For additional information, visit HHSC's 1115 Waiver website.  Performing Providers may find additional information on HHSC's DSRIP Online Reporting Tool's Bulletin Board.

 Measure Bundle Protocol

DY9-10 Draft E2-601 and E2-602 Measure Specifications

Please review draft specifications for the two newly proposed DY9-10 measures: 

- E2-601: OB Hemorrhage - Risk Assessment and 

- E2-602: OB Hemorrhage - Quantified Blood Loss

Providers should submit any questions and feedback to the waiver mailbox preferably by end of July. 

HHSC responses to questions submitted through the June 10th webinar over proposed changes to the DSRIP Measure Bundle Protocol (MBP) for DY7-10 are provided below.

The proposed changes to the Measure Bundle Protocol (MBP) for DY7-10 and an accompanying Excel file of Related Strategies are included below. Any feedback on the draft MBP should be communicated to HHSC by completing the survey for stakeholder feedback, which can be found at the following link:https://www.surveymonkey.com/r/2W9G6PV. The survey for stakeholder feedback will close on Thursday, 6/27/2019.

 Reporting - April DY8

April DY8 Reporting Webinar

The DY8 R1 (April) DSRIP Reporting Webinar was held on Thursday, April 4, 2019. A recording of the webinar can be found here: 
https://register.gotowebinar.com/recording/2896637393023421697
  

April DY8 Reporting Webinar Slides

Below please find the General Reporting and Category C slides for the webinar being held on April 4th.

General Reporting Material

Below is the April DY8 Reporting Companion and Online Reporting System User Guide
 
The Reporting Companion includes information on reporting during the first reporting period of DY8 including timelines, DY7 carryforward instructions, use of HHSC reporting templates, Category A-D guidance, and an overview of payment and IGT processing. Each DSRIP provider should review this entire Companion Document to understand the guidelines for how to report DSRIP achievement for the April DY8 reporting period.

Category C Reporting Template

The NMI reporting template has been revised to correct template errors. Please use this version of the template when reporting Category C during the NMI reporting period. 

 Category A Resources

Costs and Savings Examples

The Costs and Savings examples document provides examples illustrating different approaches to the Costs and Savings analysis. These examples are intended to help providers establish the scope of the Costs and Savings analysis as it relates to the Core Activity under review.

Cost and Savings Frequently Asked Questions (FAQ)

The Cost and Savings FAQ has been updated to include responses to the majority of questions that HHSC received from RHPs. Providers can identify newly added questions by the Posting Date and/or Topic Category (Anchor Questions). HHSC will post another version of the FAQ once all responses are finalized. 

Cost and Savings Reporting Guidance Attachments

Word versions of Attachment A: Costs and Savings Narrative Template and Attachment B: Alternative Tool Approval Request Form. These are the same attachments that are included in the Costs and Savings guidance document and are being provided separately in an editable format.

Attachment A: providers must submit this attachment to HHSC in October of DY8.

Attachment B: providers must submit this attachment only in cases where the provider is requesting to use an Alternative Tool. Deadline for submission of this attachment is December 3, 2018.

Cost and Savings Reporting Guidance

To meet the Costs and Savings reporting requirement for Category A, DSRIP Performing Providers who have a total valuation of one million dollars or more per Demonstration Year (DY) are required to submit the costs of at least one Category A Core Activity of choice and the forecasted or generated savings of that Core Activity. HHSC's guidance document provides details on the reporting requirements for Costs and Savings. It provides information on the tools that are recommended for the analysis,describes the process for receiving approvals for use of alternative tools, and includes questions that will be used during reporting in October of DY7 and DY8. The guidance document covers what questions will be available for Performing Providers who have a total valuation of less than one million dollars per DY.

Please note that individual Attachments that are currently included in the Cost and Savings guidance will be posted separately as well. 

 Category B Resources

Below please find a summary of the provider system definitions. System definitions were originally submitted through the RHP Plan Update for DY7-8 and updated through Category B plan modification requests (as applicable). The summary is current as of 6/13/2019. 

Category B - MLIU PPP Allowable Variation

Below please find the Total and MLIU PPP information that was approved during the RHP Plan Update process and the methodology used to calculate the Allowable Variation for MLIU PPP.

Category B Frequently Asked Questions (FAQ)

The Category B Frequently Asked Questions (FAQ) document provides HHSC responses to both specific and broad questions we are receiving on Category B system definition and patient population by provider (PPP) reporting. Questions and responses are organized by subject. The FAQ has been updated as of April 20, 2018.

 Category C Resources

Category C Reporting Summary Workbook

The updated Category C reporting summary workbook dated 06/26/19 is below. The workbook includes Category C measures in all regions and reflects all provider reporting through the April DY 8 Reporting Period.

Please review the updated summary workbook for accuracy, and contact HHSC if you identify any errors in the following data elements: 

  • Measure Selection
  • Milestone Structure (particularly P4P vs P4R status, and the approved achievement payer-type)
  • Baseline Measurement Period
  • Baseline or PY1 Review Status (Accepted, Flagged for TA, Pending Correction) 
  • Reporting Eligibility
  • Current Baseline or PY1 Source

NOTE: Errors in reported numerators/denominators can be corrected by submitting a correction during the Interim Corrections period, and do not need to be brought to HHSC's attention at this time. 

Category C Baseline Review and TA

HHSC has completed review of Category C baseline submitted during the October DY7, NMI and Interim Corrections reporting periods. Providers that reported baselines received a decision summary indicating the baseline review status for each baseline reported. Below are general instructions on baseline review decisions and next steps for measures flagged for TA. 

Category C Modification Request Form

The Category C Modification Request Form was updated 08/07/2018 to reflect approved modification requests and new measures. 

Category C Goal Calculator

Updated Category C Goal Calculator dated 12/14/18 to allow goal calculation for measures with an approved payer type exception for the goal achievement milestone.

Risk-Adjusting Resources for Category C 30-Day Readjusted Readmission Measures:

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

B1-217: Risk Adjusted All-Cause 30-Day Readmission

H2-216: Risk Adjusted Behavioral Health/ Substance Abuse 30-Day Readmission Rate

M1-216: Risk Adjusted Behavioral Health/ Substance Abuse 30-Day Readmission Rate

E2-A01 OB Hemorrhage Collaborative Activity

Below are documents that provide additional details for the collaborative activity that is a required component if a hospital or physician practices selects Measure Bundle E2 Maternal Safety. Measure E2-A01 refers to the Texas Department of State Health Services (DSHS) sponsored implementation of the AIM Safety Bundle for Obstetric Hemorrhage. 

7/12/19: HHSC has updated the DY8 Milestone Requirement for E2-A01: OB Hemorrhage Patient Safety Activities to take into consideration the number of Collaborative Learning Sessions that will have been offered per cohort up to September 30, 2019. Please review the highlighted changes to the E2-A01 DY8 Milestone Requirement, and submit any questions to the waiver mailbox.

 Category C Specifications

Category C Measure Specifications & FAQ

Updated Category C Measure Specifications are below. Part 1 is the introduction and applies to all provider types. Parts 2 - 4 include detailed measure specifications for measures within the provider type menu. The excel file contains all measures for all provider types.The updated specifications include previous clarifications made to providers and a change log is available as a tab in Category C Measure Specifications excel file. HHSC does not intend to make any additional changes at this time, but will update the specifications only as needed.

Providers should carefully review the Category C Measure Specifications Introduction (Part 1) for guidance on data collection and reporting, and the Category C FAQ for HHS responses to provider submitted questions regarding measure specifications. 
HHSC will update the Category C Specifications as needed and publish updated specifications at the end of each month only if needed. 

 Category D Resources

PPE Technical Notes 2017

Please find below the technical notes for the CY2017 PPE reports used for Category D Hospital reporting:

 DY7 Category D Reporting Data 

Physician Practices Data: DSRIP Statewide Analysis Report--PQI and PDI-includes Medicaid PQI and PDI data based on CY2016 and All Payer data for CY2015.

Local Health Departments Data: 

CY2016 RHP regional summary LHD dataCommunity Mental Health Centers Data: 

FY2017 DSRIP Measures - CMHC data (pdf)

 Category 3 Resources

 Category 3 reporting summaries are below. The Cat 3 RHP Summary includes all Category 3 outcomes in a given region. The Cat 3 Summary includes outcome specific summaries and the Category 3 goal calculator. These summaries contain the most recent reporting information submitted to HHSC as of 12/10/18. Providers should review the data and check for accuracy.

There will not be an additional interim corrections period. Instead, providers will need to make any needed corrections in the October DY7 Category 3 reporting template. 

Providers who need to make corrections should email the Waiver mailbox during the reporting period with the RHP number and  project ID, the outcome measure, the years requiring correction, and a detailed explanation of why the correction is needed (i.e., why the information reported previously is inaccurate and how the correction information is calculated). Once this information is reviewed, HHSC will provide instructions on how to make corrections. Please contact HHSC as early as possible in the reporting period, so that we have time to review your information and respond before the reporting period closes.

 Compliance Monitoring Resources

​MSLC Guidance for DY 7-8

- Category B System Definition Data Support Guide: assists providers in determining what data should be retained to support system definition and the PPP reporting. 

- Category C Data Support Guide: assists providers in determining data support and retention requirements

   UPDATED 4/16/18: added a technical note to the "Instructions and Guidance" tab; Added a technical note to the risk-adjusted measure descriptions for A2-384, B1-141, B1-217, H2-216, and M1-216.

   UPDATED 4/16/18: See Change Log tab for details.

- Category C Data Support Guide FAQs

   UPDATED 8/27/18

- Guidance for Texas DSRIP Risk-Adjusted Measures: updated document for DY 7-8 

- Risk Adjusting Template: an optional tool for providers to use for risk adjusting. Instructions for use of the risk adjusting template are available in the first two tabs of the template. Please direct any TA questions.regarding the risk adjusting template to MSLC. 

   UPDATED 8/27/18: Filter Column D for "Version 5" to see change

To help providers better prepare data and reporting resources for transition into the new DY7-8 structure, MSLC presented on Texas DSRIP Compliance Monitoring to Regions 8 and 17. The presentation video and materials are available at https://1115waiver.tamhsc.edu/compliance-monitoring.html . 

 Content Editor