Tools and Guidelines for Regional Healthcare Partnership Participants
HHSC continues to work with CMS to finalize revisions to Category 3 Quality Improvements in the RHP Planning Protocol. The overall objective of Category 3 is to assess the effectiveness of Category 1 and 2 interventions. HHSC's primary goal is to have a strategy that is operationally feasible at this stage of the waiver.
HHSC submitted a Category 3 Framework document to CMS on December 2, 2013 (see below for link). The proposal includes a balanced approach of a combination of Pay for Reporting (P4R) and Pay for Performance (P4P) to gain meaningful data on the impact of Category 1 and 2 projects. This framework also details methods to ensure that a.) data reported is valid and reliable and in alignment with standardized measure specifications, b.) performance measurement does not lead to adverse selection or unintended consequences for patients and c.) performance goals are set in a valid and meaningful manner in accordance with state and national performance benchmarks. The Framework document is under CMS leadership review.
For the Category 3 measures, HHSC has received feedback from CMS that most of the new measures proposed with be approved. Within the Texas Category 3 Excel file below, providers will see a new designation in this most recent submission that each measure has for P4P or P4R. Please refer to the Framework document for use of these designations. The spreadsheet also provides initial information on benchmarks that will be used to determine performance goals for P4P measures. HHSC is continuing to work to identify additional benchmarks so as many measures as possible will be available as a P4P option.
Please note that revisions are underway with the IT-9.2 series and IT-9.4 related to Emergency Department utilization. These measures were approved in the prior iterations of the Category 3 menu. However, CMS and HHSC agreed that revisions were needed in order to clarify the specifications for the use of these measures. The revised specifications for IT-9.2 and IT-9.4 can be found in the Emergency Department Measure Specifications linked to below.
The methodology that CMS has proposed for setting performance goals for P4P measures is a variation of the nationally recognized Quality Improvement System for Managed Care (QISMC) and can be found in the Draft TX Improvement Target Methodology document below. At a high level, the QISMC methodology specifies that the provider's performance goals will be set at a threshold that results in a gap reduction between the provider's baseline and the performance benchmark. Use of a standardized methodology for Category 3 performance was included in the Program Funding and Mechanics Protocol revisions that were posted in April 2013. (This protocol also was revised in September 2013, but not related to Category 3.)
For some providers, the Category 3 menu may not include a P4P option related to their Category 1 or 2 project. In these instances, providers would demonstrate improvements for P4P that is not directly related to their project but is considered a statewide priority for quality improvements. These measures are being referred to as 'Population Focused Priority' measures. The link below to the Priority Population Focused Measures spreadsheet contains tabs with measures for Community Mental Health Centers (CMHCs), Physician Practices, and Hospital providers.
Some providers, such as local Health Department providers and certain types of hospitals (such as Critical Access, Children's and Specialty hospitals), may not have appropriate P4P options in Category 3 and may not serve populations described in the 'Population Focused Priority' measures. In these instances, P4P options are under development and are being referred to as 'Stretch Activities'. HHSC has created a draft list of stretch activities which can be found in the Proposed Stretch Activities document below.
Category 3 Documents:
- Category 3 Companion Document(2/27/14)
- Category 3 Provider Selection Template (2/25/14)
- Key Points about Category 3 Framework (2/25/14)
- Category 3 Framework (2/5/14)
- Texas Category 3 (2/5/14)
- Category 3 Measures List - abbreviated (2/25/14)
- Compendium of Category 3 Measures(3/4/14)
- Emergency Department Measure Specifications (1/8/14)
- Draft TX Improvement Target Methodology (1/8/14)
- Proposed Stretch Activities (2/14/14)
- Population-Focused Priority Measures (2/14/14)
- Risk Adjustment Overview for PPE Cat 3 Measures
New 3-Year DSRIP Projects
Please find links below to the template and guidance for new 3-year DSRIP Projects. Links are included to the revised Category 1 and Category 2 sections of the RHP Planning Protocol to be used for 3-year projects. HHSC has removed project areas 2.4, 2.5, and 2.8, and project area 1.10 is limited to learning collaborative projects for the 3-year projects. The revised menu also clarifies and cleans up project metrics and designates the Quantifiable Patient Impact (QPI) metric(s) to be used for each project area. Category 3 will be revised at a later date and DSRIP providers should continue to follow the original RHP Planning Protocol for 4-year projects.
- HHSC Feedback for 3-Year Projects
- RHP Plan Template for 3-Year Projects (posted 11/20/13)
- Introduction to 3-Year RHP Planning Protocol (posted 1/9/14)
- Category 1 Menu for 3-Year Projects (posted 1/9/14)
- Category 2 Menu for 3-Year Projects (posted 1/9/14)
- Combined Prioritized List for 3-Year Projects (posted 11/20/13)
- New 3-Year Projects Workbook (posted 12/16/13)
- New 3-Year Projects Workbook Template Instructions (posted 11/20/13)
- 3-Year Projects Webinar Presentation (posted 11/20/13)
Phase 4 Regional Folders and Documents:
Please find links below to Phase 4 documents and instructions for review by Regional Healthcare Partnership (RHP) participants.
- Phase 4 Feedback (posted 1/28/14) Within each region's zip file are individual provider templates.
- Phase 4 Companion Document (update 11/8/13)
- Core Components List (updated 11/8/13)
- Plan Modification Form (posted 11/18/13)
- Phase 4 Webinar Presentation (posted 11/6/13)
- Cat 1 & 2 Project Milestones and Metrics spreadsheet (posted 11/8/13)
DY2 Reporting Templates and Instructions:
Please find links below to DY2 reporting templates and instructions for review by Regional Healthcare Partnership (RHP) participants.
- DY2 October Reporting Templates (posted 10/4/13). Within each region's zip file are individual provider templates.
- DY2 October Reporting Template Instructions (posted 10/4/13)
- DY2 Reporting Companion Document (updated 10/22/13)
- Category 3 October DY2 Reporting Template (posted 10/4/13)
- Category 4 Status of Capability to Report Template (updated 8/9/13)
- October DY2 DSRIP Reporting Webinar Presentation (posted 10/17/13)
- DSRIP Reporting Webinar Presentation (posted 8/16/13)
- Sample of a Completed Reporting Template (posted 8/16/13)
- IGT Entity Feedback Template (updated 10/4/13) This form is for IGT entities to provide feedback on their affiliated providers’ reported DY2 progress and is due to HHSC by November 15, 2013.
- HHSC Guidance for Providers on DY 2 Reporting for Category 3 measures not yet approved by CMS (posted 9/11/13)
Immediate Guidance to Regional Healthcare Partnerships (RHPs):
- RHP Annual Report Template (posted 11/20/13). The Program Funding and Mechanics Protocol requires each Anchor to submit an RHP annual report by December 15, 2013.
- Draft Revised Category 3 Quality Improvements: (updated 9/11/13): HHSC has received feedback from CMS that, of the measures proposed, CMS did not have comments or questions on 75% of the measures, which means that these look approvable to add to the menu. The measures are listed in this spreadsheet that includes both existing and new measures proposed. For measures about which CMS had questions, there are columns included that list "CMS Flag," "CMS Question" and "HHSC Response."
HHSC has also submitted additional information to CMS on assessment tools that have been proposed by providers. Most assessment tools that were proposed by providers are included. The following assessment tools have not been submitted at this time due to lack of information on either validity or reliability: Health Center Patient Satisfaction Survey; EORTC Quality of Life Questionnaire (QLQ); Barthel Index of Activities of Daily Living (ADL); Client Oriented Scale of Improvement (COSI); Traumatic Events Screening Inventory (TESI); Brief Negative Symptom Assessment (BNSA); and Addiction Severity Index (ASI).HHSC is sharing the draft revised Category 3 Menu submitted to CMS for approval, and a summary document that gives an overview of the proposed revisions to Category 3. This submission by HHSC to CMS is under review at this time; NO action is required by providers.
- Draft Process for Adding Additional 3-year DSRIP Projects: HHSC is sharing a draft process for RHPs to add DSRIP projects in Demonstration Year 3 of the Transformation Waiver.
- Phase II - FAQs for Completing the Quantifiable Patient Impact Spreadsheets: These QPI FAQs (posted 7/15/13) should help answer frequently asked questions about filling out the QPI spreadsheets. Please also remember to read the instructions included in the QPI workbook carefully.
- Phase II – List of Recommended QPI Metrics by Project Option: HHSC is providing a list of recommended Quantifiable Patient Impact (QPI) metrics (posted 7/8/2013) to help guide completion of the QPI spreadsheet in Phase II and future RHP Plan submissions.
- Summary data for CMS Initial Review Findings: HHSC is providing a list of the initial CMS review findings(updated 6/14/2013) for all projects. This document is subject to change as performing providers respond to review guidance.
- Phase 3 Overview and Guidance Document: HHSC is providing an overview of Phase 3 (updated 6/10/2013) to help providers understand the process and timeline for revising DY2 milestones and metrics for August DSRIP reporting.
- Companion Document: HHSC has revised the DRAFT version of a companion document that can be used to help providers understand the next steps they should take to revise projects in response to CMS Initial Review Findings about RHP Plans (updated 5/17/13). This document will be finalized after receiving CMS and stakeholder input
- Collaboration: On January 18, a notice was sent to all stakeholders of the Texas 1115 Transformation Waiver providing Centers for Medicare and Medicaid Services (CMS) guidance regarding Delivery System Reform Incentive Payment (DSRIP) projects that were proposed under the collaboration option (PDF) (posted 1/22/2013) in the Program Funding and Mechanics (PFM) Protocol.
- Project Valuation: Formal feedback on each Regional Healthcare Partnership (RHP) plan will include review of project valuation. This feedback is intended to help providers improve projects to justify the proposed project values based on variables the Centers for Medicare and Medicaid Services (CMS) has indicated are priorities. This guidance on project valuation (PDF) (posted 1/18/2013) was provided on January 16, 2013.
- Next Steps, Common Issues, & Summary Information: HHSC is providing Immediate Guidance (PDF) (posted 12/6/2012) to RHPs about the next steps in the plan review process, common issues identified through a high-level review of Pass 1 projects, and summary information that HHSC is requesting that providers add to the beginning of each project. HHSC requests that for the full RHP plan submission, each project (including Pass 1 projects) include key project information at the beginning of the Section V Project Description. The specific requested information is contained in the Immediate Guidance (PDF) (posted 12/6/2012).
- Contact Information Change Form(posted 5/17/13)
- Intergovernmental Transfer (IGT) Entity Change Form (posted 5/17/13)
Regional Healthcare Partnership (RHP) Planning Protocol
CMS has granted final approval of this Regional Healthcare Partnership (RHP) Planning Protocol document (PDF). This document was updated Oct. 1, 2012, to include minor technical corrections (PDF). The protocol provides the menu of project options approved by HHSC and the Centers for Medicare & Medicaid Services (CMS) that contribute to delivery transformation and quality improvement. The only projects eligible for payments from the DSRIP pool are those contained in this menu that are implemented as outlined in an RHP Plan approved by HHSC and CMS, with corresponding measures, milestones and performance improvement targets. The links below open individual sections of the approved protocol and include the Oct. 1, 2012 technical corrections.
- Introduction – RHP Planning Protocol (PDF) (posted 10/01/2012)
- Category 1 – RHP Planning Protocol (PDF) (posted 10/01/2012)
- Category 2 – RHP Planning Protocol (PDF) (posted 10/01/2012)
- Category 3 – RHP Planning Protocol (PDF) (posted 10/01/2012)
- Category 4 – RHP Planning Protocol (PDF) (posted 10/01/2012)
- Appendix – RHP Planning Protocol (PDF) (posted 10/01/2012)
CMS has provided a list of Category 3 Outcomes that will be acceptable for Workforce Projects (posted 11/2/2012).
Category 4 Guidance (posted 11/12/2012)
- Pass 1 Hospital Allocations (updated 10/12/2012)
- DSRIP Funding by CMHC
- List of Affiliation Numbers (XLS) (posted 10/5/2012)
The Agency for Healthcare Research and Quality (AHRQ) provides the following information that may be useful to Performing Providers when selecting measures for waiver projects:
Tutorial on Quality Measures details the attributes of desirable quality measures, discusses validity of measures, and provides guidance on selecting, applying and interpreting quality measures.
Quality and Patient Safety provides links to a variety of tools and toolkits.
National Quality Measures Clearinghouse (NQMC) includes links to the HHS Measures Inventory (a repository of measures currently being used by the U.S. Department of Health and Human Services) and a database of National Quality Forum (NQF) Endorsed Measures.
Regional Healthcare Partnership (RHP) Plan Template:
- Final RHP Plan Template (updated 10/12/2012)
- RHP Plan Template Companion Document (updated 10/25/2012)
- RHP Plan Anchor Checklist (posted 10/10/2012)
- Sample Project (posted 10/15/2012) – Provides a sample Category 2 project with related Category 3 outcomes
Program Funding and Mechanics Protocol:
A change to the Program Funding and Mechanics Protocol is effective September 6, 2013 to allow HHSC to require that DSRIP intergovernmental transfer (IGT) entities transfer additional funds to fund the non-federal share of waiver monitoring costs. This change is reflected in the Program Funding and Mechanics Protocol (see attachment J), paragraphs 42 and 49(e) (posted 9/11/13).
A summary of the DSRIP Project Requirements (posted 8/31/2012) also is available.
Uncompensated Care Tool:
Please visit the Rate Analysis for Hospital Services website for information regarding the Uncompensated Care Reporting Tools and Transition Payments.
Regional Healthcare Partnership Information:
- List of RHP Websites (PDF) (posted 1/18/2013)
- Regional Healthcare Partnership Governance Overview (PDF)
- Regional Healthcare Partnership Principles (PDF) (posted 4/2/2012)
- Anchor List (PDF) (updated 2/28/14)
- Regional Healthcare Partnership Map (PDF) - (updated 8/7/2012)
Other Planning Tools:
Each regional healthcare partnership must submit a plan to HHSC. The following documents are intended to help with the planning process.
- Community Data and Resources for Assessment of Needs (DOC) (posted 3/2012)
- HITECH Funding Available to Hospitals (DOC) (posted 4/2012)
- Emergency and Outpatient Utilization Data for Texas Acute Care Hospitals by County, 2010 (PDF) (posted 1/2012)
- Exempt Small and Rural Hospitals
- Major Safety Net Hospitals by Regional Healthcare Partnership (PDF) (updated 10/12/2012)
- Links to public and private affiliation forms (posted 10/23/2012):
- Frequently Asked Questions (FAQ) (updated 10/25/2012)
- Resources for Workforce-Related Projects: Alliance for Health Reform Toolkits (posted 11/06/2012)
Other HHSC Guidelines:
- Guidelines for Intergovernmental Transfers (PDF)
- DSRIP Funding and Reporting Flow (PDF) (posted 4/2/2012)
- TEXNET Instructions (DOC)