SECTION 354.1751. Category B Requirements for Performers

(a) A performer must provide the following information in the RHP plan update for DY9-10 for its RHP:

(1) its updated total PPP for DY5, DY6, DY7, or DY8, if needed;

(2) its updated MLIU PPP for DY5, DY6, DY7, or DY8, if needed;

(3) its Medicaid PPP for DY7 and DY8; and

(4) its LIU PPP for DY7 and DY8.

(b) HHSC will use the information provided by a performer in accordance with subsection (a)(1) - (a)(2) of this section to update as necessary the performer's:

(1) total PPP baseline;

(2) MLIU PPP baseline;

(3) MLIU PPP to total PPP ratio baseline;

(4) MLIU PPP goal for a DY; 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 HHSC approved a performer's request for an exception to its total PPP baseline or MLIU PPP baseline being calculated as described in subsection (c) or (d):

(1) the performer's total PPP baseline is equal to its total PPP for DY5 only and its MLIU PPP baseline is equal to its MLIU PPP for DY5 only; or

(2) the performer's total PPP baseline is equal to its total PPP for DY6 only and its MLIU PPP baseline is equal to 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 DY9 and DY10 is equal to its MLIU PPP baseline, as calculated in subsection (d) or (e) of this section, except as follows:

(1) If a performer submits a RHP plan modification request to change its MLIU PPP for DY9 or DY10, and HHSC approves the request, the performer's MLIU PPP goal for the applicable DY is determined by HHSC.

(2) If a performer updates its MLIU PPP for DY9 or DY10 in the RHP Plan Update for DY9-10, the performer's MLIU PPP goal for the applicable DY is determined by HHSC.

(h) A performer's allowable MLIU PPP goal variation per DY for DY9 and DY10 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 of DY9 and DY10. 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 each DY of DY9 and DY10:

(1) its MLIU PPP for the DY;

(2) its total PPP for the DY;

(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.

(4) its Medicaid PPP for the DY; and

(5) its LIU PPP for the DY.

(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 §354.1751 adopted to be effective November 12, 2019, 44 TexReg 6854