|(a) Introduction. This section establishes the quality
metrics that may be used in the Quality Incentive Payment Program
(QIPP) for nursing facilities (NFs) on or after September 1, 2019.
(b) Definitions. The following definitions apply when
the terms are used in this section. Terms that are used in this and
other sections of this subchapter may be defined in §353.1301
(relating to General Provisions) or §353.1302 (relating to Quality
Incentive Payment Program for Nursing Facilities on or after September
1, 2019) of this subchapter.
(1) Baseline--A NF-specific initial standard used as
a comparison against NF performance in each metric throughout the
program period to determine progress in the QIPP 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 NF's progress throughout the program period.
(c) Quality metrics. For each program period, HHSC
will designate one or more quality metrics. Any quality metric included
in QIPP will be evidence-based. HHSC may modify quality metrics from
one program period to the next. The proposed quality metrics for a
program period will be presented to the public for comment in accordance
with subsection (f) of this section.
(d) Performance requirements. For each program period,
HHSC will specify the performance requirements associated with designated
quality metrics. The proposed performance requirements for a program
period will be presented to the public for comment in accordance with
subsection (f) of this section. Achievement of performance requirements
will trigger payments for the QIPP capitation rate components as described
in §353.1302 of this subchapter.
(e) Quality assurance. All data and documentation supplied
to HHSC by the NF to demonstrate achievement of performance requirements
is subject to validation and audit. HHSC will select a random, representative
sample of participating NFs for quality assurance review each program
period and will conduct reviews on one-fourth of the total sample
each program quarter.
(1) If selected, the NF will have 14 business days
from the date of the request from HHSC to submit to HHSC the required
data and documentation.
(2) If the selected NF fails to participate in the
review or to provide the required data or documentation, any payments
to the provider for the quality metric or component under review may
be considered an Overpayment and subject to recoupment or adjustment
as described in §353.1301(k) of this subchapter.
(f) Notice and hearing.
(1) HHSC will publish notice of the proposed metrics
and their associated performance requirements no later than December
1 of the calendar year that precedes the first month of the program
period. The notice must be published either by publication on HHSC's
Internet web site 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 the HHSC regarding the proposed metrics and performance
(B) the date, time, and location of a public hearing.
(2) Written comments will be accepted within 15 business
days of 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) Quality metric publication. Final quality metrics
and performance requirements will be provided through the QIPP webpage
on HHSC's website on or before February 1 of the calendar year that
also contains the first month of the program period.
(h) Substitution of Measures. Alternate measures may
be substituted for measures proposed under subsection (f) of this
section or adopted under subsection (g) of this section if required
by the Centers for Medicare and Medicaid Services for federal approval
of the program.
|Source Note: The provisions of this §353.1304 adopted to be effective December 30, 2018, 43 TexReg 8079; amended to be effective August 19, 2021, 46 TexReg 5015; amended to be effective May 31, 2022, 47 TexReg 3113