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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.

 Reporting - October DY7

Estimated IGT for DY7 Round 2

Please review the yellow highlighted columns for DY7 Round 2 estimated DSRIP payments, estimated DSRIP IGT, and remaining DY7 Monitoring IGT due. The estimated payments are based on the assumption that all milestones reported as achieved in DY7 Round 2 will be approved by HHSC. These estimates are provided to inform any needed IGT changes in entities or proportion and may not reflect all potential payments. Changes are due to HHSC by December 4, 2018, 5:00pm using the IGT Change Form located on the DSRIP Online Reporting System Bulletin Board, under Other 1115 Medicaid Waiver Forms. The FMAP for January 2019 payments is 58.19.

Do not use these estimates to submit IGT. Rate Analysis will notify IGT Entities and Anchors of the actual IGT due the week of December 17, 2018.

October DY7 Reporting Webinar (Overview + Cats A, B, D): 
https://player.vimeo.com/video/293428587

October DY7 Reporting Webinar (Cat C):  
https://player.vimeo.com/video/293480078

General Reporting Materials

Below please find the October DY7 Reporting Companion Document and two versions of the DSRIP Online Reporting System User Guide. The April DY7 version focuses on the reporting process for DY2-6 projects with DY6 carryforward, while the October DY7 version focuses on the reporting process for new DY7-8 provider-level projects.

Category C NMI Reporting Template

Category C NMI Reporting Template is below. This template is intended for reporting for measures with a "Needs More Information" determination for milestone RM-1 in the DY7R2 primary reporting period.

Category D Reporting

October DY7 Category D Reporting Template
Physician Practices Reporting: 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 Reporting: CY 2016 RHP regional summary LHD data - a regional summary provided by HHSC and DSHS with the 2016 data from the Texas Behavioral Risk Factor Surveillance System. Data for each region is presented on individual tabs.
Community Mental Health Centers Reporting: FY 2017 DSRIP Measures - CMHC data rev_20181003 (pdf) - includes data for all centers for these selected measures based on the data from Fiscal Year 2017. (Revision posted 10/03/2018)

Quantifiable Patient Impact (QPI) Reporting

Below please find the October DY7 QPI Reporting Template and QPI Reporting Companion Document. The QPI Reporting Template is required when reporting metric achievement and must be completed by each project with a DY6 carryforward QPI metric that has yet to report achievement in order to fulfill SAR requirements.
 
Please note that an updated version of the QPI reporting template has been posted 10/26/2018 for providers that were erroneously receiving a pop-up message saying that their reporting has been completed and had open DY5 data entry fields. Providers who have already completed and submitted their QPI templates without issue do not need to redo their template.

Category 3 Reporting Template

Template version 1.2 updated to correct reporting eligibility for certain PFPM measures

The Category 3 reporting template may display an inaccurate PY4 measurement period for certain providers that previously reported PY3B. Providers should continue to use the posted template, but note the correct PY4 measurement period in the qualitative fields. PY4 is always the 12 months following the selected PY3B measurement period. 

 Category A Resources

Cost and Savings Frequently Asked Questions (FAQ)

The Costs and Savings Frequently Asked Questions (FAQ) document provides HHSC responses to questions related to the Costs and Savings portion of Category A. Questions and responses are organized by topic category and include references to sections in the Costs and Savings guidance document for additional information. The Costs and Savings guidance document is also posted to the DSRIP Online Reporting System Bulletin Board and can be found under the Category A Resources header.

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

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.
 
Please note that the deadline for Category B plan modifications that would impact the October DY7 reporting cycle was July 1, 2018. Providers who did not meet this deadline and may have significant changes to their system definition and/or baseline Total and MLIU PPP should wait to report their DY7 Category B metric in April DY8, once they are able to request a plan modification. As a reminder, Category B plan modifications must be submitted 90 days prior to the first day of the semi-annual reporting period.

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 Baseline Review and TA Overview

HHSC has completed review of Category C baseline submitted during the October DY7 reporting period. Providers that reported baselines received a decision summary on December 14th 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. HHSC sent this attachment to all DSRIP providers and anchors on December 13th. 

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 Reporting Summary Workbook

The updated Category C reporting summary workbook dated 12/14/18 is below. The Summary includes Category C measures in all regions and reflects baselines reported in Summer DY7 and October DY7, as well as baseline review status. 

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:


A2-384: Risk Adjusted CHF 30-Day Readmission Rate
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. Draft milestone requirements are included as well as additional information from DSHS on the collaborative. 

 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 Category C Specifications FAQ was updated 07/30/2018 and  includes a general list of approved approximate baseline scenarios for informational purposes. HHSC will continue to update the Category C FAQ 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 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

 Reporting - April DY7

​Category 3 Reporting 

The link below is to the April DY7 Category 3 Reporting Template. The template must be submitted by all providers with a Category 3 DY6 carryforward milestone for semi-annual reporting. Please refer to the general April DY7 Reporting Companion Document for additional guidance on Category 3 reporting.

 Content Editor