1 Tex. Admin. Code § 353.1304 - Quality Metrics for the Quality Incentive Payment Program for Nursing Facilities on or after September 1, 2019
(a)
Introduction. This section establishes the quality metrics that may be used in
the Quality Incentive Payment Program (QIPP) for nursing facilities (NFs) on or
after September 1, 2019.
(b)
Definitions. The following definitions apply when the terms are used in this
section. Terms that are used in this and other sections of this subchapter may
be defined in §353.1301 (relating to General Provisions) or §353.1302
(relating to Quality Incentive Payment Program for Nursing Facilities on or
after September 1, 2019) of this subchapter.
(1) Baseline--A NF-specific initial standard
used as a comparison against NF performance in each metric throughout the
program period to determine progress in the QIPP quality metrics.
(2) Benchmark--A metric-specific initial
standard set prior to the start of the program period and used as a comparison
against a NF's progress throughout the program period.
(c) Quality metrics. For each program period,
HHSC will designate one or more quality metrics. Any quality metric included in
QIPP will be evidence-based. HHSC may modify quality metrics from one program
period to the next. The proposed quality metrics for a program period will be
presented to the public for comment in accordance with subsection (f) of this
section.
(d) Performance
requirements. For each program period, HHSC will specify the performance
requirements associated with designated quality metrics. The proposed
performance requirements for a program period will be presented to the public
for comment in accordance with subsection (f) of this section. Achievement of
performance requirements will trigger payments for the QIPP capitation rate
components as described in §
353.1302 of this
subchapter.
(e) Quality assurance.
All data and documentation supplied to HHSC by the NF to demonstrate
achievement of performance requirements is subject to validation and audit.
HHSC will select a random, representative sample of participating NFs for
quality assurance review each program period and will conduct reviews on
one-fourth of the total sample each program quarter.
(1) If selected, the NF will have 14 business
days from the date of the request from HHSC to submit to HHSC the required data
and documentation.
(2) If the
selected NF fails to participate in the review or to provide the required data
or documentation, any payments to the provider for the quality metric or
component under review may be considered an Overpayment and subject to
recoupment or adjustment as described in §
353.1301(k) of
this subchapter.
(f)
Notice and hearing.
(1) HHSC will publish
notice of the proposed metrics and their associated performance requirements no
later than December 1 of the calendar year that precedes the first month of the
program period. The notice must be published either by publication on HHSC's
Internet web site or in the Texas Register. The notice
required under this section will include the following:
(A) instructions for interested parties to
submit written comments to the HHSC regarding the proposed metrics and
performance requirements; and
(B)
the date, time, and location of a public hearing.
(2) Written comments will be accepted within
15 business days of publication. There will also be a public hearing within
that 15-day period to allow interested persons to present comments on the
proposed metrics and performance requirements.
(g) Quality metric publication. Final quality
metrics and performance requirements will be provided through the QIPP webpage
on HHSC's website on or before February 1 of the calendar year that also
contains the first month of the program period.
(h) Substitution of Measures. Alternate
measures may be substituted for measures proposed under subsection (f) of this
section or adopted under subsection (g) of this section if required by the
Centers for Medicare and Medicaid Services for federal approval of the
program.
Notes
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