The Quality Incentive Payment Program encourages nursing facilities to improve the quality and innovation of their services. Improvement is based upon several indices of success, including quality metrics that are collected by the Centers for Medicare & Medicaid Services.
During the 83rd Legislative Session, the Texas Legislature outlined its goals for the incorporation of nursing facilities in Medicaid managed care. The Texas Health and Human Services Commission was directed to encourage transformative efforts in the delivery of nursing facility services, including "efforts to promote a resident-centered care culture through facility design and services provided."
In 2014, HHSC established the Minimum Payment Amount Program, which became effective in 2015. MPAP established minimum payment amounts for qualified nursing facilities in STAR+PLUS. The STAR+PLUS managed care organizations paid the minimum payment amounts to qualified nursing facilities based on state direction. The program was intended to be a short-term program that would ultimately transition to a performance-based initiative.
HHSC Budget Rider 97 in the 2016-2017 budget directed HHSC to transition the Minimum Payment Amount Program to the Quality Incentive Payment Program. The QIPP is a Medicaid managed care delivery system and provider payment initiative in which HHSC directs expenditures through its contracts with the STAR+PLUS MCOs. Federal authority for such directed expenditures is codified at 42 Code of Federal Regulations §438.6(c).
QIPP Years One and Two
For QIPP years one (Sept. 1, 2017 to Aug. 31, 2018) and two (Sept. 1, 2018 to Aug. 31, 2019), QIPP funds are paid through three components of the STAR+PLUS nursing facility managed care per member per month capitation rates. The budget for year one was $399,333,542 and the budget for year two is $446 million.
Component One is available for non-state government-owned nursing facilities and is triggered by the nursing facility’s submission of a monthly Quality Assurance Performance Improvement Validation Report.
Components Two and Three are available to all participating QIPP facilities and are triggered by meeting the national benchmark or by demonstrating minimum improvement (Component Two) or strong improvement (Component Three) on the following CMS long-stay nursing facility quality metrics:
- High-risk long-stay residents with pressure ulcers.
- Percent of residents who received an antipsychotic medication.
- Residents experiencing one or more falls with major injury.
- Residents who were physically restrained.
QIPP Year Three
HHSC has proposed significant changes to the QIPP program for year three. Updates will be posted in this website location upon CMS approval of these program revisions.
If you have questions for HHSC, email: QIPP@hhsc.state.tx.us.
Managed Care Organization Contacts
Director of Network Strategy and Business Development
VP, Provider Performance
VP Long Term Care Operations
Director of Network Operations