SECTION 354.1711. Category B Requirements for Performers

(a) A performer must provide the following information in the RHP plan update for its RHP to be eligible for its RHP plan update submission funds for DY7 and its Category B valuation for DY7 and DY8:

(1) its total PPP for DY5;

(2) its total PPP for DY6;

(3) its MLIU PPP for DY5; and

(4) its MLIU PPP for DY6.

(b) HHSC will use the information provided by a performer in accordance with subsection (a) of this section to calculate the performer's:

(1) total PPP baseline;

(2) MLIU PPP baseline;

(3) MLIU PPP goal;

(4) MLIU PPP to total PPP ratio baseline; and

(5) allowable MLIU PPP goal variation.

(c) A performer's total PPP baseline is equal to the average of its total PPP for DY5 and its total PPP for DY6 with the exception described in subsection (e) of this section.

(d) A performer's MLIU PPP baseline is equal to the average of its MLIU PPP for DY5 and its MLIU PPP for DY6 with the exception described in subsection (e) of this section.

(e) If a performer demonstrates good cause, the performer may request in the RHP plan update that:

(1) its total PPP baseline equal its total PPP for DY5 only and its MLIU PPP baseline equal its MLIU PPP for DY5 only; or

(2) its total PPP baseline equal its total PPP for DY6 only and its MLIU PPP baseline equal its MLIU PPP for DY6 only.

(f) A performer's MLIU PPP to total PPP ratio baseline is equal to the performer's MLIU PPP baseline, as calculated in subsection (d) or (e) of this section, divided by the total PPP baseline, as calculated in subsection (c) or (e) of this section.

(g) A performer's MLIU PPP goal per DY for DY7 and DY8 is equal to its MLIU PPP baseline, as calculated in subsection (d) or (e) of this section.

(h) A performer's allowable MLIU PPP goal variation per DY for DY7 and DY8 is calculated with consideration of the performer's:

(1) size;

(2) provider type; and

(3) MLIU PPP to total PPP ratio baseline, as calculated in subsection (f) of this section.

(i) A performer will have a MLIU PPP milestone for each DY. The valuation of the MLIU PPP milestone for a DY is 100 percent of the performer's Category B valuation for the DY.

(j) A performer must report the following to be eligible for payment of its MLIU PPP milestone for a DY:

(1) its MLIU PPP for the DY;

(2) its total PPP for the DY; and

(3) an explanation for any decrease in the performer's MLIU PPP to total PPP ratio for the DY from the calculation in subsection (f) of this section.

(k) A performer must report the information in subsection (j) of this section during the second reporting period of the DY it is reporting to be eligible for payment of the MLIU PPP milestone for the DY, with the exception that a performer may request to carry forward reporting of its MLIU PPP milestone to the first reporting period of the DY immediately following the DY it is reporting; however, if approved, the measurement period would not change.

Source Note: The provisions of this §354.1711 adopted to be effective December 1, 2017, 42 TexReg 6609; amended to be effective April 26, 2018, 43 TexReg 2393