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TITLE 1ADMINISTRATION
PART 15TEXAS HEALTH AND HUMAN SERVICES COMMISSION
CHAPTER 353MEDICAID MANAGED CARE
SUBCHAPTER ODELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES
RULE §353.1307Quality Metrics and Required Reporting Used to Evaluate the Success of the Comprehensive Hospital Increase Reimbursement Program

(a) Introduction. This section establishes the quality metrics and required reporting that may be used in the Comprehensive Hospital Increase Reimbursement Program (CHIRP).

(b) Definitions. The following definitions apply when the terms are used in this section and in metrics and performance requirements developed under subsections (f) and (g) of this section. Terms that are used in this section may be defined in §353.1301 of this subchapter (relating to General Provisions) or §353.1306 of this subchapter (relating to the Comprehensive Hospital Increase Reimbursement Program for program periods on or after September 1, 2021).

  (1) Baseline--An initial standard used as a comparison against performance in each metric throughout the program period to determine progress in the CHIRP quality metrics.

  (2) Benchmark--A metric-specific initial standard set prior to the start of the program period and used as a comparison against an individual hospital or hospital class's progress throughout the program period.

  (3) Measurement period--The time period used to measure achievement of a quality metric.

(c) Quality metrics. For each program period, HHSC will designate one or more quality metrics that HHSC will evaluate for each CHIRP capitation rate component as described in §353.1306(g) of this subchapter.

  (1) Each quality metric will be identified as a structure, process, or outcome measure.

  (2) Each quality metric will be evidence-based.

(d) Quality metrics and program evaluation. HHSC will use reported performance of quality metrics to evaluate the degree to which the arrangement advances at least one of the goals and objectives that are incentivized by the payments described under §353.1306(g) of this subchapter.

(e) Participating Hospital Reporting Frequency.

  (1) Participating hospitals will be required to report quarterly unless otherwise specified by the metric. The reported information will be used to conduct interim evaluations of the program.

  (2) Participating hospitals will also be required to furnish information and data related to quality measures and performance requirements established in accordance with subsection (f) of this section within 30 calendar days after a request from HHSC for more information.

(f) Notice and hearing.

  (1) HHSC will publish notice of the proposed metrics and their associated performance requirements no later than January 31 preceding the first month of the program period. The notice must be published either by publication on HHSC's website or in the Texas Register. The notice required under this section will include the following:

    (A) instructions for interested parties to submit written comments to HHSC regarding the proposed metrics and performance requirements; and

    (B) the date, time, and location of a public hearing.

  (2) Written comments will be accepted for 15 business days following publication. There will also be a public hearing within that 15-day period to allow interested persons to present comments on the proposed metrics and performance requirements.

(g) Publication of Final Metrics and Performance Requirements. Final quality metrics and performance requirements will be provided through HHSC's website on or before February 28 of the calendar year that also contains the first month of the program period. If Centers for Medicare and Medicaid Services requires changes to quality metrics or performance requirements after February 28 of the calendar year but before the first month of the program period, HHSC will provide notice of the changes through HHSC's website.

(h) Evaluation Reports.

  (1) HHSC will evaluate the success of the program based on a statewide review of reported metrics. HHSC may publish more detailed information about specific performance of various participating hospitals, classes of hospitals, or service delivery areas.

  (2) HHSC will publish interim evaluation findings regarding the degree to which the arrangement advanced the established goal and objectives of each capitation rate component.

  (3) HHSC will publish a final evaluation report within 270 days of the conclusion of the program period.


Source Note: The provisions of this §353.1307 adopted to be effective March 28, 2021, 46 TexReg 1977

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