CMS has agreed to maintain flexibilities approved for Categories B and C for DY9 reporting into DY10. HHSC is currently updating the PFM to reflect the following accommodations:
Category B:
CMS approved use of a higher Allowable Variation than the standard 5 percent. DY10 Allowable Variation will be updated to a flat percentage of 15% for all providers (please note that this is a reduction from 35% that was used for DY9). This final value took into consideration the average decrease in reported MLIU PPP between DY8 and DY9 by DSRIP providers and trends in national encounter data (e.g., studies by the Commonwealth Fund and Journal of the American Medical Association on the impact of COVID-19 on patient visits). Providers participating in the studies saw a decrease in patient visits between 5-10% between October 2020 and June 2021. DSRIP providers saw an average decrease in MLIU PPP of 8% between DY8 and DY9. The final value was rounded up to 15% to also account for the original 5% maximum allowable variation.
As a result of this change, the payment tiers for DY10 Category B metrics will be 100%, 75%, 50%, and 0%.
Category C:
Providers are required to report calendar year 2021 data to be eligible for payment on the Category C DY10 achievement milestones.
For measures selected for DY7-10, the PY4 achievement value for DY10 achievement milestones and DY9 carryforward achievement milestones will be based on the greater of:
For measures that were newly-selected for DY9-10, the PY4 achievement value for DY10 achievement milestones and DY9 carryforward achievement milestones will be based on the greater of:
The “Category C Achievement Values for CY2020” file is posted to the online reporting system bulletin board under the Category C Resources section and can be used to view the estimated average achievement values by measure or bundle. This data is provided for informational purposes. The actual average achievement value for an AM-10 milestone is based on all PY2 reporting as of the October DY10 Needs More Information (NMI) reporting period (February 2021).