|(a) Introduction. This section establishes the quality
metrics and required reporting that may be used in the Directed Payment
Program for Behavioral Health Services.
(b) Definitions. The following definitions apply when
the terms are used in this section. Terms that are used in this section
may be defined in §353.1301 (relating to General Provisions)
or §353.1320 (relating to Directed Payment Program for Behavioral
Health Services) of this subchapter.
(1) Baseline--An initial standard used as a comparison
against performance in each metric throughout the program period to
determine progress in the program's quality metrics.
(2) Benchmark--A metric-specific initial standard set
prior to the start of the program period and used as a comparison
against a community mental health center's (CMHC'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, the Texas
Health and Human Services Commission (HHSC) will designate quality
metrics for each of the program's capitation rate components as described
in §353.1320(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 and
will be presented to the public for comment in accordance with subsection
(e) of this section.
(d) Performance requirements. For each program period,
HHSC will specify the performance requirement that will be associated
with the designated quality metric that is expected to advance at
least one of the goals and objectives in the Medicaid quality strategy.
Achievement of performance requirements will trigger payments for
the program's capitation rate components as described in §353.1320(h)
and be used 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 §353.1320(h) of this subchapter.
For some quality metrics, achievement is tested merely on whether
a CMHC meets or does not meet the established requirement. The following
performance requirements are associated with the quality metrics described
in subsection (c) of this section.
(1) Reporting of quality metrics. All quality metrics
must be reported for the CMHC to be eligible for payment.
(2) Achievement of quality metrics.
(A) To achieve a structure measure, a CMHC must report
its progress on associated activities for each measurement period.
(B) To achieve an IOS or benchmark measure, a CMHC
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, achievement of an
IOS measure will be establishing a baseline.
(3) Reporting frequency. CMHCs must report quality
metric achievement semi-annually, unless otherwise specified by the
(4) Other metrics related to improving the quality
of care for Texas Medicaid beneficiaries. If HHSC develops additional
metrics for inclusion in the Directed Payment Program for Behavioral
Health Services, the associated performance requirements will be presented
to the public for comment in accordance with subsection (e) of this
(e) Notice and hearing.
(1) HHSC will publish notice of the proposed quality
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;
(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.
(f) 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 the 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.