(2) Component Two.
(A) The total value of Component Two will be equal
to 30 percent of remaining QIPP funds after accounting for the funding
of Component One and Component Four.
(B) Allocation of funds across qualifying non-state
government-owned and private NFs will be proportional, based upon
historical Medicaid days of NF service.
(C) Monthly payments to NFs will be triggered by achievement
of performance requirements as described in §353.1304 of this
subchapter.
(3) Component Three.
(A) The total value of Component Three will be equal
to 70 percent of remaining QIPP funds after accounting for the funding
of Component One and Component Four.
(B) Allocation of funds across qualifying non-state
government-owned and private NFs will be proportional, based upon
historical Medicaid days of NF service.
(C) Quarterly payments to NFs will be triggered by
achievement of performance requirements as described in §353.1304
of this subchapter.
(4) Component Four.
(A) The total value of Component Four will be equal
to 16 percent of the funds of the QIPP.
(B) Allocation of funds across qualifying non-state
government-owned NFs will be proportional, based upon historical Medicaid
days of NF service.
(C) Quarterly payments to non-state government-owned
NFs will be triggered by achievement of performance requirements as
described in §353.1304 of this subchapter.
(D) Private NFs are not eligible for payments from
Component Four.
(5) Funds that are non-disbursed due to failure of
one or more NFs to meet performance requirements will be distributed
across all QIPP NFs based on each NF's proportion of total earned
QIPP funds from Components One, Two, Three, and Four combined.
(h) Distribution of QIPP payments.
(1) Prior to the beginning of the eligibility period,
HHSC will calculate the portion of each PMPM associated with each
QIPP-enrolled NF broken down by QIPP capitation rate component, quality
metric, and payment period. For example, for a NF, HHSC will calculate
the portion of each PMPM associated with that NF that would be paid
from the MCO to the NF as follows.
(A) Monthly payments from Component One as performance
requirements are met will be equal to the total value of Component
One for the NF divided by twelve.
(B) Monthly payments from Component Two associated
with each quality metric will be equal to the total value of Component
Two associated with the quality metric divided by twelve.
(C) Quarterly payments from Component Three associated
with each quality metric will be equal to the total value of Component
Three associated with the quality metric divided by four.
(D) Quarterly payments from Component Four associated
with each quality metric will be equal to the total value of Component
Four associated with the quality metric divided by four.
(E) For purposes of the calculations described in subparagraphs
(B), (C), and (D) of this paragraph, each quality metric will be allocated
an equal portion of the total dollars included in the component.
(F) In situations where a NF does not have enough data
for a quality metric to be calculated, the funding associated with
that metric will be evenly distributed across all remaining metrics
within the component.
(2) MCOs will distribute payments to enrolled NFs as
they meet their reporting and quality metric requirements. Payments
will be equal to the portion of the QIPP PMPM associated with the
achievement for the time period in question multiplied by the number
of member months for which the MCO received the QIPP PMPM. In the
event of a CHOW, the MCO will distribute the payment to the owner
of the NF at the time of the payment.
(i) Changes of ownership.
(1) A NF undergoing a CHOW from privately owned to
non-state government owned or from non-state government owned to privately-owned
will only be eligible to enroll as the new class of facility if HHSC
received a completed CHOW application no later than 30 days prior
to the first day of the enrollment period. All required documents
pertaining to the CHOW (i.e., HHSC must have a complete application
for a change of ownership license as described under 40 TAC §19.201
(relating to Criteria for Licensing), 40 TAC §19.210 (relating
to Change of Ownership and Notice of Changes), and 40 TAC §19.2308
(relating to Change of Ownership)) must be submitted in the timeframe
required by HHSC.
(2) If an enrolled NF changes ownership, including
to a new class of facility during the pendency of the application
or during the eligibility period, the NF under the new ownership must
meet the eligibility requirements described in this section for the
new owner's facility class in order to continue QIPP participation
during the eligibility period.
(3) An enrolled NF must notify the MCOs it has contracts
with of a potential CHOW at least 30 days before the anticipated date
of the CHOW. An enrolled NF must also notify the HHSC Rate Analysis
Department by hand delivery, United States (U.S.) mail, or special
mail delivery at least 30 days before the anticipated date of the
CHOW. Notification is considered to have occurred when HHSC receives
the notice.
(j) Changes in operation. If an enrolled NF closes
voluntarily or ceases to provide NF services in its facility, the
NF must notify the HHSC Rate Analysis Department by hand delivery,
United States (U.S.) mail, or special mail delivery within 10 business
days of closing or ceasing to provide NF services. Notification is
considered to have occurred when HHSC receives the notice.
(k) Recoupment. Payments under this section may be
subject to recoupment as described in §353.1301(j) and §353.1301(k)
of this subchapter.
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