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(A)Monthly payments from Component One as a uniform
rate increase 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 quality metrics 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
(relating to Criteria for Licensing) and 26 TAC §554.210 (relating
to Change of Ownership and Notice of Changes) 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 or during
the program 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 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. Notification is considered to have occurred when the
MCO 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.
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 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 May 11, 2022
TRD-202201840 Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Effective date: May 31, 2022
Proposal publication date: March 18, 2022
For further information, please call: (512) 424-6637
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