DY6 – The “Transition” Year Program Funding and Mechanics Protocol (PFMP) June 23, 2016

“Transition” to What? Best Case Scenario Worst Case Scenario DY7 thru DY10 Worst Case Scenario Phase-out 25% reduction in funding over 4 years

DY6A and DY6B DY6A DY6B Oct 1, 2016 thru Sep 30, 2017 A full Federal Fiscal Year (12 months) DY6B Oct 1, 2017 thru Dec 31, 2017 To complete the Calendar Year (3 months)

New Definition - MLIU Old Definition New Definition Medicaid/Low-Income Uninsured Used in DY2 thru DY5 New Definition Medicaid and Low-Income or Uninsured Used in DY6 (and beyond)

MLIU To qualify as MLIU QPI Enrolled in Medicaid at the time of at least one encounter during the DY Qualified as Low-Income or Uninsured Below 200% of Federal Poverty Level (FPL) OR at the time of at least on encounter during the DY Uninsured at the time of a separate encounter during the DY If patient was on Medicaid and then became Low-Income or Uninsured during the DY Counted as “Medicaid” for DSRIP purposes Either Individuals Served OR Encounters Provided Stipulated by the project

Continuing Projects Must be “eligible” Providers decide: HHSC notified all providers in January 2016 Providers decide: CONTINUE Project in DY6 DISCONTINUE Project in DY6 Submit a “replacement” project Replacement project cannot start any earlier than DY6B

Discontinuing Projects May NOT propose “replacement” projects until after December 2017 (earliest) INELIGBLE projects (as deemed by HHSC) May NOT participate in extension period DY6A or DY6B May have opportunity to “use the funds” No earlier than DY6B

Withdrawal of Projects Prior to Jan 2018 (before DY7 2nd Payment) Recoupment of ALL DY6A and DY6B payments Between Jan 1, 2018 (after DY7 2nd Payment) and March 30, 2018 (before DY8 R1) No Recoupment DY6A or DY6B payments After April 1, 2018 (DY8 R1) Recoupment of any payments made after the date of withdrawal

DSRIP Pool Allocation - State $3.875 Billion $3.1 Billion for DY6A $775 Million for DY6B Funding Distribution for DY6A Hospital Providers Cat 1 and 2 -- no more than 57% Cat 3 – at least 33% Cat 4 – no more than 10% Non-Hospital Providers Cat 1 and 2 – no more than 80% Cat 3 – at least 20%

Cat 1 and 2 Requirements (Milestones) Standardized for ALL projects Four (4) Total Milestones 2 Quantitative 2 Qualitative 1. Total QPI Value is 25% 2. MLIU QPI 3. Core Component Report 4. Sustainability Plan

Milestone 1: Total QPI HHSC will determine the target Same as DY5 (TOTAL QPI Goal) May request variance from HHSC (TBD)** Grouping must be same as DY5 No changes Pre-DSRIP baselines remain the same Carry Forward IS allowed

Milestone 2: MLIU QPI If project had MLIU goal in DY5 DY6 goal is same as DY5 goal Pre-DSRIP baseline stays same If project had no MLIU goal in DY5 DY6 is Pre-DSRIP QPI x %MLIU (DY3 or earliest on record) EXAMPLE MLIU QPI is PFP

Milestone 3: Core Component Reporting Based on Project Category Each Core Component must be addressed Usually 3 or 4 of these ALL have a Continuous Quality Improvement (CQI) Element EXAMPLE

Milestone 4: Sustainability Plan Project Level “How does the institution plan to keep this project going when the DSRIP dollars are gone?” Plan should Include Systems for Exchange of Health Information Integration into Managed Care Collaboration with other community partners Project Level Evaluation Return On Investment Quantifiable Outcomes

Category 3 Requirements P4P Outcomes will continue in DY6 Using same baselines for DY4 & DY5 Projects with P4R and PFPM in DY5 Report PFPM ONLY in DY6

Category 3 Goal Calculations QISMC Outcomes: Baselines remain the same for projects** If baseline BELOW Minimum Performance Level (MPL) MPL + 0.15*(HPL-MPL) If baseline BETWEEN MPL & HPL Whichever is GREATER: Baseline + 0.25*(HPL – baseline) OR Baseline + 0.10*(HPL – MPL) If baseline ABOVE High Performance Level (HPL) Whichever is LESSER: Baseline + 0.10* (HPL – MPL) OR Baseline + 0.125*(1 – Baseline) May result in lower DY6 goals !!

Category 3 Goal Calculations IOS Outcomes: Baselines remain the same for projects** 12.5% Gap closure Baseline + 0.125*(perfect – baseline) POSITIVE IMPROVEMENT Baseline – 0.125*(Baseline) NEGATIVE IMPROVEMENT IOS Surveys Pre-Test/ Post Test Scenario 1 PostTest Baseline + 0.125* (PostTest Baseline – PreTest Baseline) Average Score Scenario 2 & 3 Baseline + 0.125*(Max Score – Baseline)

Category 3 Goal Calculations Population Focused Priority Measures (PFPM) Same as Cat 3 Outcomes Stretch Activities Select NEW stretch activity for DY6 OR Select a Population Focused Performance Measure (PFPM) MAY duplicate an existing PFPM Baseline Periods must be used per DY DUE September 9th

QUESTIONS? oscar.perez@umcelpaso.org