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(ii)percent of residents who received an antipsychotic
medication (long-stay);
(iii)residents experiencing one or more falls with
major injury; and
(iv)residents who were physically restrained.
(B)Quality metrics may change from eligibility period
to eligibility period but will always be limited to those under the
CMS Five-Star Quality Rating System. Information regarding specific
quality metrics for an eligibility period will be provided annually
through the QIPP webpage on the HHSC website on or before February
1 of the calendar year that also contains the first month of the eligibility
period.
(C)Quality metric baselines will be based on each
individual NF's average performance on the metric as reported by CMS
for the federal quarter that ends prior to the first day of the eligibility
period and the three prior federal quarters, or as determined by HHSC.
(D)Quality metric benchmarks will be based on the
national average for the metric as reported by CMS for the federal
quarter that ends prior to the first day of the eligibility period,
or as determined by HHSC.
(2)Achievement requirements. In order to receive payments
from Components Two and Three for a quality metric, a NF must show
improvement over the baseline or exceed the benchmark for the metric.
(A)To qualify for a payment from Component Two, a
NF must meet at least the initial quarterly goal of 1.7 percent improvement
from the baseline, with subsequent quarterly goals increasing to a
maximum of seven percent by the end of the eligibility period. For
example, to qualify for a payment from Component Two for a quality
metric for the second quarter of the eligibility period, the NF must
meet at least the second quarter goal of 3.4 percent improvement from
the baseline.
(B)To qualify for a payment from Component Three,
a NF must meet at least the initial quarterly goal of 5.0 percent
improvement from the baseline with subsequent quarterly goals increasing
to a maximum of 20 percent by the end of the eligibility period. For
example, to qualify for a payment from Component Three for a quality
metric for the second quarter of the eligibility period, the NF must
meet at least the second quarter goal of 10.0 percent improvement
from the baseline. A NF that qualifies for a payment from Component
Three for a metric automatically qualifies for a payment from Component
Two for the same metric.
(C)A NF that exceeds the benchmark for a metric qualifies
for a payment from both Component Two and Component Three for that
metric. A NF that exceeds the benchmark may decline in performance
and still qualify for a payment from both Component Two and Component
Three as long as the NF continues to exceed the benchmark for the
metric.
(j)Changes of ownership.
(1)If an enrolled NF changes ownership during the
eligibility period to private ownership, the NF under the new ownership
must meet the private NF eligibility requirements described in this
section in order to continue QIPP participation during the eligibility
period.
(2)If a non-state government-owned NF changes ownership
during the eligibility period to another non-state governmental entity,
the NF under the new ownership must meet the non-state government-owned
eligibility requirements described in this section in order to continue
QIPP participation during the eligibility period.
(k)Recoupment. Payments under this section may be
subject to recoupment as described in §353.1301(k) of this subchapter.
The agency certifies that legal counsel
has reviewed the adoption and found it to be a valid exercise of the
agency's legal authority.
Filed with the Office
of the Secretary of State on November 30, 2018
TRD-201805110 Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: December 30, 2018
Proposal publication date: October 12, 2018
For further information, please call: (512) 424-6637
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