(E)For program periods beginning on or before
September 1, 2023, but on or after September 1, 2019, NFs must
report quality data as described in §353.1304 of this subchapter
as a condition of participation in the program.
(F)For program periods beginning
on or after September 1, 2024, payments to NFs will be triggered by
achievement of performance requirements as described in §353.1304
of this subchapter.
(2)Component Two.
(A)The total value of Component Two will be equal
to: [a percent of remaining QIPP funds after accounting
for the funding of Component One and Component Four.]
(i)For the program periods beginning on or before
September 1, 2020, but on or after [period] September
1, 2019, [through August 31, 2021, the percent will be equal
to] 30 percent of total program value for the program period
after accounting for the funding of Component One and Component Four.
(ii)For the program periods [period]
beginning on or before September 1, 2023, but on or after September
1, 2021, [the percent will be equal to] 40 percent of
total program value for the program period after accounting for the
funding of Component One and Component Four.
(iii)For program periods beginning
on or after September 1, 2024, 20 percent of total program value for
the program period.
(B)Allocation of funds across qualifying non-state
government-owned and private NFs will be proportional, based upon
historical Medicaid days of NF service.
(C)Payments [Monthly payments]
to NFs will be triggered by achievement of performance requirements
as described in §353.1304 of this subchapter or, if applicable
in a program period, a uniform rate increase for which a NF
must report quality data as described in §353.1304 of this subchapter
as a condition of participation in the program.
(3)Component Three.
(A)The total value of Component Three will be equal
to: [a percent of remaining QIPP funds after accounting
for the funding of Component One and Component Four.]
(i)For the program periods beginning on or before
September 1, 2020, but on or before [period] September
1, 2019, [through August 31, 2021, the percent will be equal
to] 70 percent total program value for the program period
after accounting for the funding of Component One and Component Four .
(ii)For the program periods [period]
beginning on or before September 1, 2023, but on or after September
1, 2021, [the percent will be equal to] 60 percent after
accounting for the funding of Component One and Component Four.
(iii)For the program period beginning
September 1, 2024, 20 percent of the program period funds.
(B)Allocation of funds across qualifying non-state
government-owned and private NFs will be proportional, based upon
historical Medicaid days of NF service.
(C)Payments [Quarterly payments]
to NFs will be triggered by achievement of performance requirements
as described in §353.1304 of this subchapter.
(4)Component Four.
(A)The total value of Component Four will be equal
to 16 percent of the total program value for the program period [
funds of the QIPP].
(B)Allocation of funds across qualifying non-state
government-owned NFs will be proportional, based upon historical Medicaid
days of NF service.
(C)Payments [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 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)Component One.
(i)For the program periods beginning
on or before September 1, 2023, but on or after September 1, 2019,
monthly [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.
(ii)For program periods beginning
on or after September 1, 2024, quarterly payments from Component One
associated with each quality metric will be equal to the total value
of Component One associated with the quality metric divided by four.
(B)Component Two.
(i)For the program periods beginning
on or before September 1, 2023, but on or after September 1, 2019,
monthly [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.
(ii)For program periods beginning
on or after September 1, 2024, quarterly 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 four.
(C)Component Three. For program periods beginning
on or after September 1, 2019, quarterly [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)Component Four. For program periods beginning
on or after September 1, 2019, quarterly [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)Allocation Across Quality Metrics
(i)For program periods beginning on
or before September 1, 2023, but on or after September 1, 2019, for [
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.
(ii)For program periods beginning
on or after September 1, 2024, for purposes of the calculations described
in subparagraph (A) of this paragraph, achievement in 1 metric earns
90 percent and achievement in 2 metrics earns 100 percent of total
dollars included in the component. For 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 [government owned]
or from non-state government-owned [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)For program periods beginning
on or after September 1, 2025, if an enrolled NF undergoes a CHOW
that changes the class of the facility, from privately owned to non-state
government-owned or from non-state government-owned to privately owned,
during the program period, the enrolled NF will be removed from the
program for the remainder of the program period after the CHOW effective
date.
(4)[(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@hhs.texas.gov
[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 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 October 31, 2023
TRD-202304038 Karen Ray
Chief Counsel
Texas Health and Human Services Commission
Earliest possible date of adoption: December 17, 2023
For further information, please call: (737) 867-7817
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