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

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

3. 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)

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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 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%

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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

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

18. 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

19. QUESTIONS?