|(a) Introduction. This section establishes the quality
metrics that may be used in the Rural Access to Primary and Preventive
Services (RAPPS) program.
(b) Definitions. The following definitions apply when
the terms are used in this section. Other terms used in this section
may be defined in §353.1301 of this subchapter (relating to General
Provisions) or §353.1315 of this subchapter (relating to Rural
Access to Primary and Preventive Services Program).
(1) Baseline--An initial standard used as a comparison
against performance in each metric throughout the program period to
determine progress in a RAPPS quality metric.
(2) Benchmark--A metric-specific initial standard set
prior to the start of the program period and used as a comparison
against a rural health clinic's (RHC's) progress throughout the program
(3) Measurement period--The time period used to measure
achievement of a quality metric.
(c) Quality metrics. For each program period, the Texas
Health and Human Services Commission (HHSC) will designate quality
metrics for each RAPPS capitation rate component as described in §353.1315(h)
of this subchapter.
(1) Each quality metric will be identified as a structure
measure, improvement over self (IOS) measure, or benchmark measure.
(2) Each quality metric will be evidence-based.
(d) Quality metric requirements. For each program period,
HHSC will specify the requirements that will be associated with the
designated quality metric.
(1) Reporting of quality metrics. An RHC must report
all quality metrics as a condition of participation in the program.
An RHC must stratify any reported data by payor type and must report
data according to requirements published under subsection (g) of this
(2) Achievement of quality metrics.
(A) To achieve a structure measure, an RHC must report
its progress on associated activities for each measurement period.
(B) To achieve an IOS or benchmark measure, an RHC
must meet or exceed the measure's goal for a measurement period. Goals
will be established as either a target percentage improvement over
self or performance above a benchmark as specified by the metric and
determined by HHSC. In year one of the program, providers will establish
a baseline for IOS measures.
(e) Participating RHC reporting frequency. Participating
RHCs must report quality metrics semi-annually unless otherwise specified
by the quality metric. Participating RHCs 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
(f) Notice and hearing.
(1) HHSC will publish notice of the proposed quality
metrics and their associated 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 requirements;
(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 requirements.
(g) Publication of final metrics and requirements.
Final quality metrics and 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 the Centers for Medicare
and Medicaid Services requires changes to quality metrics or requirements
after February 28, HHSC will provide notice of the changes through
(h) Evaluation Reports.
(1) HHSC will evaluate the success of the program based
on a review of reported metrics. HHSC may publish more detailed information
about specific performance of various participating RHCs, classes
of RHCs, 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.