Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 353 - MEDICAID MANAGED CARE › Subchapter O - DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES › Section 353.1303 - Quality Incentive Payment Program for Nursing Facilities before September 1, 2019

Current through Reg. 49, No. 28; July 12, 2024
(a) Introduction.
				  This section establishes the Quality Incentive Payment Program (QIPP) for
				  nursing facilities (NFs) providing services under Medicaid managed care (MC)
				  before September 1, 2019. QIPP is designed to incentivize NFs to improve
				  quality and innovation in the provision of NF services to Medicaid recipients,
				  using the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality
				  Rating System as its measure of success.
(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 §
										RSA 353.1301
				  of this subchapter (related to General Provisions).
(1) Baseline--A NF-specific starting measure
				  used as a comparison against NF performance throughout the eligibility period
				  to determine progress in the QIPP Quality Measures.
(2) Benchmark--The CMS National Average prior
				  to the start of the eligibility period by which a NF's progress with the
				  Quality Measures is determined.
(3)
				  CHOW application--An application filed with the Department of Aging and
				  Disability Services (DADS) for a NF change of ownership (CHOW).
(4) DADS--The Texas Department of Aging and
				  Disability Services or its successor agency.
(5) Eligibility period--A period of time for
				  which an eligible and enrolled NF may receive the QIPP amounts described in
				  this section. Each QIPP eligibility period is equal to a state fiscal year (FY)
				  beginning September 1 and ending August 31 of the following year. Eligibility
				  Period One is equal to FY 2018, beginning September 1, 2017, and ending August
				  31, 2018.
(6) MCO--A Medicaid
				  managed care organization contracted with HHSC to provide NF services to
				  Medicaid recipients.
(7) Network
				  nursing facility--A NF that has a contract with an MCO for the delivery of
				  Medicaid covered benefits to the MCO's enrollees.
(8) Non-state government-owned NF--A network
				  NF where a non-state governmental entity holds the license and is a party to
				  the NF's Medicaid provider enrollment agreement with the state.
(9) Private NF--A NF that is not owned by a
				  governmental entity.
(10) Quality
				  Assurance Performance Improvement (QAPI) Validation Report--A monthly report
				  submitted by a NF, that is eligible for and enrolled in QIPP, to an MCO that
				  demonstrates that the NF has convened a meeting to review the NF's
				  CMS-compliant plan for maintaining and improving safety and quality in the
				  NF.
(11) Regional Healthcare
				  Partnership (RHP)--A collaboration of interested participants that work
				  collectively to develop and submit to the state a regional plan for health care
				  delivery system reform as defined and established under Chapter 354, Subchapter
				  D, of this title (relating to Texas Healthcare Transformation and Quality
				  Improvement Program).