|(a) Introduction. This section establishes the quality
metrics for the Comprehensive Hospital Increase Reimbursement Program
(b) Definitions. Terms that are used in this and other
sections of this subchapter 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).
(c) Quality metrics. For each program period, HHSC
will designate one or more quality metrics for each CHIRP capitation
rate component as described in §353.1306(g) of this subchapter.
Any quality metric included in CHIRP will be evidence-based and will
be identified as a structure, process, or outcome measure. 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 (g) 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 (g) of this section. Achievement of performance requirements
will trigger payments as described in §353.1306 of this subchapter.
(e) 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 (h) of this section.
(f) Participating Hospital Reporting Frequency.
(1) Participating hospitals will be required to report
on quality metrics semiannually unless otherwise specified by the
(2) Participating hospitals will also be required to
furnish information and data related to quality metrics and performance
requirements established in accordance with subsection (g) of this
section within 30 calendar days after a request from HHSC for more
(g) Notice and hearing.
(1) HHSC will publish notice of the proposed metrics
and their associated performance requirements no later than August
10 of the calendar year that precedes 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 within 30 calendar
days of publication. There will also be a public hearing within that
30-day period to allow interested persons to present comments on the
proposed metrics and performance requirements.
(h) Quality metric publication. Final quality metrics
and performance requirements will be provided through the CHIRP quality
webpage on HHSC's website on or before October 1 of the calendar year
that precedes the first month of the program period.
(i) Alternate measures may be substituted for measures
proposed under subsection (g) of this section or published under subsection
(h) of this section if required by the Centers for Medicare and Medicaid
Services for federal approval of the program. If Centers for Medicare
and Medicaid Services requires changes to quality metrics or performance
requirements after October 1, HHSC will provide notice of the changes
through HHSC's website.
(j) 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.
|Source Note: The provisions of this §353.1307 adopted to be effective March 28, 2021, 46 TexReg 1977; amended to be effective May 31, 2022, 47 TexReg 3113; amended to be effective January 29, 2024, 49 TexReg 404