(B)Allocation of funds across qualifying non-state
government-owned NFs will be proportional, based upon historical Medicaid
days of NF service.
(C)Quarterly payments to non-state government-owned
NFs will be triggered by achievement of performance requirements as
described in §353.1304 of this subchapter.
(D)Private NFs are not eligible for payments from
Component Four.
(5)Funds that are non-disbursed due to failure of
one or more NFs to meet performance requirements will be distributed
across all QIPP NFs based on each NF's proportion of total earned
QIPP funds from Components One, Two, Three, and Four combined.
(h)Distribution of QIPP payments.
(1)Prior to the beginning of the program [
eligibility] period, HHSC will calculate the portion of each
PMPM associated with each QIPP-enrolled NF broken down by QIPP capitation
rate component, quality metric, and payment period. For example, for
a NF, HHSC will calculate the portion of each PMPM associated with
that NF that would be paid from the MCO to the NF as follows.
(A)Monthly payments from Component One as performance
requirements are met will be equal to the total value of Component
One for the NF divided by twelve.
(B)Monthly payments from Component Two associated
with each quality metric will be equal to the total value of Component
Two associated with the quality metric divided by twelve.
(C)Quarterly payments from Component Three associated
with each quality metric will be equal to the total value of Component
Three associated with the quality metric divided by four.
(D)Quarterly payments from Component Four associated
with each quality metric will be equal to the total value of Component
Four associated with the quality metric divided by four.
(E)For purposes of the calculations described in subparagraphs
(B), (C), and (D) of this paragraph, each quality metric will be allocated
an equal portion of the total dollars included in the component.
(F)In situations where a NF does not have enough data
for all [a] quality metrics [metric
] to be calculated, the funding associated with that metric
will be evenly distributed across all remaining metrics within the
component. If a NF does not have enough data for any quality
metrics to be calculated, no funds will be earned.
(2)MCOs will distribute payments to enrolled NFs as
they meet their reporting and quality metric requirements. Payments
will be equal to the portion of the QIPP PMPM associated with the
achievement for the time period in question multiplied by the number
of member months for which the MCO received the QIPP PMPM. In the
event of a CHOW, the MCO will distribute the payment to the owner
of the NF at the time of the payment.
(i)Changes of ownership.
(1)A NF undergoing a CHOW from privately owned to
non-state government owned or from non-state government owned to privately-owned
will only be eligible to enroll as the new class of facility if HHSC
received a completed CHOW application no later than 30 days prior
to the first day of the enrollment period. All required documents
pertaining to the CHOW (i.e., HHSC must have a complete application
for a change of ownership license as described under 26 TAC §554.201
[40 TAC §19.201] (relating to Criteria for
Licensing)[,] and 26 TAC §554.210 [40
TAC §19.210] (relating to Change of Ownership and Notice
of Changes)[, and 40 TAC §19.2308 (relating to Change of
Ownership)]) must be submitted in the timeframe required by
HHSC.
(2)If an enrolled NF changes ownership, including
to a new class of facility following the enrollment period [
during the pendency of the application] or during the program [
eligibility] period, the NF under the new ownership must meet
the eligibility requirements described in this section for the new
owner's facility class in order to continue QIPP participation during
the program [eligibility] period.
(3)An enrolled NF must notify the MCOs it has contracts
with of a potential CHOW at least 30 days before the anticipated date
of the CHOW. [An enrolled NF must also notify the HHSC Rate Analysis
Department by hand delivery, United States (U.S.) mail, or special
mail delivery at least 30 days before the anticipated date of the
CHOW.] Notification is considered to have occurred when the
MCO [HHSC] receives the notice.
(j)Changes in operation. If an enrolled NF closes
voluntarily or ceases to provide NF services in its facility, the
NF must notify the HHSC Provider Finance Department by email
at qipp@hhsc.state.tx.us [Rate Analysis Department by hand
delivery, United States (U.S.) mail, or special mail delivery within
10 business days of closing or ceasing to provide NF services].
Notification is considered to have occurred when HHSC receives the
notice.
(k)Recoupment. Payments under this section may be
subject to recoupment as described in §353.1301(j) and §353.1301(k)
of this subchapter.
The agency certifies that legal counsel
has reviewed the proposal and found it to be within the state agency's
legal authority to adopt.
Filed with the Office
of the Secretary of State on May 14, 2021
TRD-202101946 Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: June 27, 2021
For further information, please call:
(512) 424-6637
|