Quality Incentive Payment Program for Nursing Homes

The Quality Incentive Payment Program serves as a resource to help nursing facilities achieve transformation. This performance-based program encourages NFs to improve the quality and innovation of their services through implementation of program-wide improvement processes for which facilities are compensated for meeting or exceeding certain goals. Improvement is based upon several indices of success, including quality metrics that are collected by the Centers for Medicare & Medicaid Services.

Background

During the 83rd Legislative Session, the Texas Legislature directed that nursing facility services be included in Medicaid managed care. The Texas Health and Human Services Commission was instructed 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 NFs in STAR+PLUS. The STAR+PLUS managed care organizations paid the minimum payment amounts to qualified NFs 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 regulatory authority for such directed payments is contained in 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 were 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 was $446 million.

Component One was exclusively available to non-state government-owned NFs and was triggered by the nursing facility’s submission of a monthly Quality Assurance Performance Improvement Validation Report.

Components Two and Three were available to all participating QIPP facilities and were 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

For QIPP Year Three (Sept. 1, 2019 to Aug. 31, 2020), QIPP funds are paid through four components of the STAR+PLUS nursing facility managed care per member per month capitation rates. The budget for year three is $600 million.

Component One is available for non-state government-owned NFs on a monthly basis and is triggered by the nursing facility’s submission of a monthly Quality Assurance Performance Improvement Validation Report. Facilities must demonstrate significant involvement of their partner entity in the monthly meetings.

Component Two is available to all participating QIPP facilities on a monthly basis and is triggered by demonstrating a commitment to workforce development as measured by the following three equally-weighted quality metrics:

  • NF maintains four additional hours of registered nurse staffing coverage per day, beyond the CMS mandate.
  • NF maintains eight additional hours of RN staffing coverage per day, beyond the CMS mandate.
  • NF has a staffing recruitment and retention program that includes a self-directed plan and monitoring outcomes.

Component Three is available to all participating QIPP facilities on a quarterly basis and is triggered by meeting the national benchmark or by demonstrating strong improvement on the following three equally-weighted CMS long-stay nursing facility quality metrics:

  • (CMS N015.02; NHC 453) Percent of high-risk long-stay residents with pressure ulcers, including unstageable ulcers.
  • (CMS N031.02; NHC 419) Percent of residents who received an antipsychotic medication.
  • (CMS N035.02; NHC 451) Percent of residents whose ability to move independently has worsened.

Component Four is available to non-state government-owned NFs on a quarterly basis and is triggered by meeting quality requirements for three equally-weighted quality metrics:

  • (CMS N024.01; NHC 407) Percent of residents with a urinary tract infection.
  • (Self-reported) Percent of residents whose pneumococcal vaccine is up to date.
  • Facility has an infection control program that includes antibiotic stewardship. The program incorporates policies and training as well as monitoring, documenting, and providing staff with feedback.

For more details related to QIPP Year Three metrics, please reference QIPP Year Three Quality Metrics (PDF).

Contact Information

If you have questions for HHSC, email: QIPP@hhsc.state.tx.us.

Managed Care Organization Contacts

Amerigroup
Jessica McFarlin
TXQIPP@amerigroup.com
817-456-6720

United
Marianne Hanley
Director of Network Strategy and Business Development
marianne.hanley@optum.com
972-372-5665

Superior
Paula Swenson
VP, Provider Performance
QIPP@superiorhealthplan.com
512-993-2492

Molina
Bob Kalin
VP Long Term Care Operations
robert.kalin@molinahealthcare.com
281-676-2269

Cigna-HealthSpring
Jquonda Brown
Director of Network Operations
State_Compliance@healthspring.com
770-779-5500

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