The Executive Commissioner of the Texas Health and Human Services Commission (HHSC) proposes amendments to §353.1302, concerning Quality Incentive Payment Program for Nursing Facilities on or after September 1, 2019; and §353.1304, concerning Quality Metrics for the Quality Incentive Payment Program for Nursing Facilities on or after September 1, 2019.

BACKGROUND AND PURPOSE

In order to continue incentivizing Texas nursing facilities (NFs) to improve quality and innovation in the provision of services, HHSC is proposing to amend the Quality Incentive Payment Program (QIPP) quality metrics that HHSC may select for each program year as well as certain component funding allocations beginning in program year five (i.e., September 1, 2021 through August 31, 2022).

Section 353.1302 would be amended to adjust QIPP Component 2 and Component 3 funding allocations as follows: increase the allocation percentage from 30 percent to 40 percent in Component 2 (paid monthly); and decrease the allocation percentage from 70 percent to 60 percent in Component 3 (paid quarterly).

The additional proposed amendments would discontinue an unnecessary requirement, provide increased clarity, and ensure that the language in this section corresponds to similar language in other sections of Subchapter O.

Section 353.1304 would be amended to remove set types of quality metrics and related performance requirements for each program year in favor of a public notice and hearing process. This proposed change allows the program to be adapted on an annual basis to ensure quality objectives are continually improved. This amendment would also clarify HHSC's validation requirements for reviews of self-reported data in the program.

SECTION-BY-SECTION SUMMARY

The proposed amendments to §353.1302 and §353.1304 replace all instances of the term "eligibility period" with "program period" to make these rules consistent with other rules regarding directed payment programs. In addition, amendments update "Rate Analysis Department" to the department's new title, "Provider Finance Department."

The proposed amendment to §353.1302(b) adds new paragraph (7) to define the term "runout period" to mean the 23 months following the end of the program period.

The proposed amendment to §353.1302(e) removes paragraph (1) and renumbers the subsection. Clarifying edits are made to new paragraph (1); text added to new paragraph (2) updates the certification requirements associated with a provider's use of QIPP funds; new paragraph (3) clarifies the requirements when a participating provider undergoes a change of ownership impacting eligibility in the program; and new paragraph (4) requires HHSC access to and provider maintenance of eligibility and enrollment records and data.

The proposed amendment to §353.1302(f) clarifies paragraphs (1), (2), and (4).

The proposed amendment to §353.1302(g) makes clarifying edits in paragraph (1) and revises the component funding allocations in paragraphs (2) and (3).

The proposed amendment to §353.1302(h) makes clarifying edits in paragraph (1) and revises subparagraph (F) to provide that no funds will be earned if a NF does not have enough data for any quality metrics to be calculated.

The proposed amendments to §353.1302(i) and §353.1302(j) make clarifying edits and update outdated references.

The proposed amendment to §353.1304(b) makes clarifying edits and removes the examples in paragraphs (1) and (2).

The proposed amendment to §353.1304(c) removes paragraphs (1) - (6) to allow HHSC to designate evidence-based quality metrics for each program period. This change will ensure the program can be adapted on an annual basis to ensure quality objectives are continually improved.

The proposed amendment to §353.1304(d) removes paragraphs (1) - (6) to allow HHSC to specify the performance requirements associated with the designated quality metrics for each program period.

The proposed amendment to §353.1304 creates a new subsection (e) related to quality assurance and the process HHSC will follow to validate provider data and documentation.

The proposed amendment to §353.1304 renumbers current subsections (e) and (f).

Current §353.1304(g) is deleted as any service delivery methodology associated with a quality metric will be provided as part of the public notice and hearing process.

FISCAL NOTE

Trey Wood, Chief Financial Officer, has determined that for each year of the first five years that the rules will be in effect, enforcing or administering the rules do not have foreseeable implications relating to costs or revenues of state or local governments.

GOVERNMENT GROWTH IMPACT STATEMENT

HHSC has determined that during the first five years that the rules will be in effect:

(1) the proposed rules will not create or eliminate a government program;

(2) implementation of the proposed rules will not affect the number of HHSC employee positions;

(3) implementation of the proposed rules will result in no assumed change in future legislative appropriations;

(4) the proposed rules will not affect fees paid to HHSC;

(5) the proposed rules will not create a new rule;

(6) the proposed rules will not expand, limit, or repeal existing rules;

(7) the proposed rules will not change the number of individuals subject to the rules; and

(8) HHSC has insufficient information to determine the proposed rules' effect on the state's economy.

SMALL BUSINESS, MICRO-BUSINESS, AND RURAL COMMUNITY IMPACT ANALYSIS

Trey Wood, Chief Financial Officer, has also determined that there will be no adverse economic effect on small businesses, micro-businesses, or rural communities. Participation in the program described in the proposed rules is optional.

LOCAL EMPLOYMENT IMPACT

The proposed rules will not affect a local economy.

COSTS TO REGULATED PERSONS

Texas Government Code §2001.0045 does not apply to these rules because the rules do not impose a cost on regulated persons.

PUBLIC BENEFIT AND COSTS

Victoria Grady, Director of Provider Finance, has determined that for each year of the first five years the rules are in effect, the public benefit will be continued incentivizing of NFs to improve quality and innovation in the provision of NF services.

Trey Wood has also determined that for the first five years the rules are in effect, there are no anticipated economic costs to persons who are required to comply with the proposed rules. Participation in the QIPP program is voluntary.

TAKINGS IMPACT ASSESSMENT

HHSC has determined that the proposal does not restrict or limit an owner's right to his or her property that would otherwise exist in the absence of government action and, therefore, does not constitute a taking under Texas Government Code §2007.043.

PUBLIC COMMENT

Written comments on the proposal may be submitted to HHSC Provider Finance Department, Mail Code H-400, P.O. Box 85200, Austin, Texas 78705-5200, or by email to QIPP@hhsc.state.tx.us.

To be considered, comments must be submitted no later than 31 days after the date of this issue of the Texas Register. Comments must be (1) postmarked or shipped before the last day of the comment period; (2) hand-delivered before 5:00 p.m. on the last working day of the comment period; or (3) emailed before midnight on the last day of the comment period. If the last day to submit comments falls on a holiday, comments must be postmarked, shipped, or emailed before midnight on the following business day to be accepted. When emailing comments, please indicate "Comments on Proposed Rules 21R069" in the subject line.

STATUTORY AUTHORITY

The amendments are authorized by Texas Government Code §531.033, which provides the Executive Commissioner of HHSC with board rulemaking authority; Texas Human Resources Code §32.021 and Texas Government Code §531.021(a), which provide HHSC with the authority to administer the federal medical assistance (Medicaid) program in Texas; Texas Government Code §531.021(b-1), which establishes HHSC as the agency responsible for adopting reasonable rules governing the determination of fees, charges, and rates for Medicaid payments under the Texas Human Resources Code, Chapter 32; and by Texas Government Code §533.002, which authorizes HHSC to implement the Medicaid managed care program.

The amendments affect Texas Human Resources Code, Chapter 32; Texas Government Code, Chapter 531; and Texas Government Code Chapter 533. No other statutes, articles, or codes are affected by the amendments.