(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 provider'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) Quality Metric requirements. For each program period,
HHSC will specify the requirements 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. Quality
metric data will 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.
(1) Reporting of quality metrics. All quality metrics
must be reported as a condition of participation in the program. Participating
providers must stratify any reported data by payor type and must report
data according to requirements published under subsection (f) of this
section.
(2) Reporting frequency. Providers must report quality
metrics semi-annually, unless otherwise specified by the metric. Participating
providers will also be required to furnish information and data related
to quality measures and performance requirements established in accordance
with subsection (e) of this section within 30 calendar days after
a request from HHSC for more information.
(3) 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
section.
(e) 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;
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 requirements.
(f) 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 of the calendar year, HHSC will provide notice of
the changes through HHSC's website.
(g) 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 providers,
classes of providers, 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.
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