| (a) Introduction. This section establishes the quality
metrics and required reporting that may be used in the Comprehensive
Hospital Increase Reimbursement Program (CHIRP).
(b) Definitions. The following definitions apply when
the terms are used in this section and in metrics and performance
requirements developed under subsections (f) and (g) of this section.
Terms that are used in this section may be defined in §353.1301
of this subchapter (relating to General Provisions) or §353.1306
of this subchapter (relating to the Comprehensive Hospital Increase
Reimbursement Program for program periods on or after September 1,
2021).
(1) Baseline--An initial standard used as a comparison
against performance in each metric throughout the program period to
determine progress in the CHIRP quality metrics.
(2) Benchmark--A metric-specific initial standard set
prior to the start of the program period and used as a comparison
against an individual hospital or hospital class'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, HHSC
will designate one or more quality metrics that HHSC will evaluate
for each CHIRP capitation rate component as described in §353.1306(g)
of this subchapter.
(1) Each quality metric will be identified as a structure,
process, or outcome measure.
(2) Each quality metric will be evidence-based.
(d) Quality metrics and program evaluation. HHSC will
use reported performance of quality metrics 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 §353.1306(g)
of this subchapter.
(1) All quality metrics for which a hospital is eligible
based on class must be reported by the participating hospital as a
condition of participation.
(2) Participating hospitals must stratify any reported
data by payor type and must report data according to requirements
published under subsection (f) of this section.
(e) Participating Hospital Reporting Frequency.
(1) Participating hospitals will be required to report
semiannually unless otherwise specified by the metric. The reported
information will be used to conduct interim evaluations of the program.
(2) Participating hospitals 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
information.
(f) Notice and hearing.
(1) HHSC will publish notice of the proposed 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;
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 performance requirements.
(g) 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 Centers
for Medicare and Medicaid Services requires changes to quality metrics
or performance requirements after February 28 of the calendar year,
HHSC will provide notice of the changes through HHSC's website.
(h) 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 hospitals,
classes of hospitals, 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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