What is QIPP?

The Quality Incentive Payment Program (QIPP) encourages nursing facilities to improve the quality and innovation of their services, using the Centers for Medicare & Medicaid (CMS) 5-star rating system as its measure of success for the following 4 quality measures:

  • High-risk long-stay residents with pressure ulcers
  • Percent of residents who received an antipsychotic medication (long-stay)
  • Residents experiencing one or more falls with major injury
  • Residents who were physically restrained

Background

During the 83rd Legislative Session, the Texas Legislature outlined its goals for adding managed care to nursing facilities. The Texas Health and Human Services Commission (HHSC) 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 (MPAP), which became effective in 2015. MPAP establishes minimum payment amounts for qualified nursing facilities in STAR+PLUS. The STAR+PLUS managed care organizations pay 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 (PDF) directs HHSC to transition the Minimum Payment Amount Program to the Quality Incentive Payment Program.

Communications

Resources

Quality Metric Toolkits

QIPP Year 1 Quality Metric National Average: Benchmarks

Below are the National Average Benchmarks for the four quality measures that NFs participating in QIPP year 1 will have their improvement measured against. Please be aware that these benchmarks will remain the same for the entire year (Sept. 1, 2017 through Aug. 31, 2018).
Quality Measure Percent of residents who received an antipsychotic medication (long-stay) (QM419) High-risk residents with pressure ulcers (QM403) Residents who were physically restrained (QM409) Residents experiencing one or more falls with major injury (QM410)
National Average: Benchmarks
(date data pulled: 8/1/2017)
16.06% 5.67% .53% 3.35%

Contact Information

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

Managed Care Organization Contacts
MCO Name Email Phone
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 Jquonda.Brown@healthspring.com 770-779-5500

QIPP QAPI Q&A

What should the title of my QAPI Validation Report form include?

The title of the QAPI Validation Report form file must include the following:

  • Facility Name
  • Month and Year The QAPI Meeting Took Place
    • Example: Stoneybrook Manor Sept. 2017

Where should I send my questions related to QAPI and QIPP?

Send questions regarding QAPI and QIPP to QIPP@hhsc.state.tx.us.

My facility is private, do I need to turn in a QAPI Validation Report form?

No, private nursing facilities participating in QIPP are not eligible for payments under QIPP Component One, therefore you will not need to turn in a QAPI Validation Report form.

What is the due date of my monthly QAPI Validation Report form?

The monthly QAPI Validation Report form is due by close of business (COB) no later than the 1st business day following the end of the month being reported. For example, Sept. 2017 QAPI Validation Report forms are due to HHSC in the required email box no later than COB on Oct. 2, 2017.

What happens if HHSC doesn't receive my QAPI Validation Report form by the deadline?

If a participating facility fails to submit their QAPI Validation Report form by the deadline it will result in a forfeiture of that month's QIPP Component One payment.

QIPP Q&A

How is the baseline determined?

The baseline will be an NF-specific average of the previous 4 quarters of published CMS data, before the start of the QIPP program. This number will remain the same for the entire year; however, each NFs baseline may change before the start of each new QIPP year.

What is the benchmark for each QM that my NF will be measured against?

The benchmark for each QM that all NFs will be measure against is the most recent CMS-published national percentage.

Does the percentage payout occur monthly or quarterly?

Quarterly

Will NFs participating in QIPP need to contract with 1 MCO or several MCOs?

NFs should contract with all of the MCOs in their service delivery area.

What is the percentage payout for improvements that are made to the quality measures?

Component 2 - Minimum Improvement

  • The maximum amount of funds available is recalculated every 6 months.
    • Allocation of funds across qualifying non-state government-owned and private nursing facilities will be based upon historical Medicaid days of nursing facility service.
    • A quarterly target for improvement for each measure is met (see table below) starting with 1.7 percent in the first quarter and increasing quarterly to 7 percent by the fourth quarter.
    • The total value of Component 2 will be equal to 35 percent of remaining QIPP funds after accounting for the funding of Component 1.
    • Quarterly payments to nursing facilities will be triggered by improvement on specific indicators.
Component 2 quarterly target for improvement
Quarter Total Improvement from Baseline
1 1.7%
2 3.4%
3 5.1%
4 7%

Component 3 - Strong Improvement

  • The maximum amount of funds available is recalculated every 6 months.
    • The total value of Component 3 will be equal to 65 percent of remaining QIPP funds after accounting for the funding of Component 1.
    • Allocation of funds across qualifying non-state government-owned and private nursing facilities will be based upon historical Medicaid days of nursing facility service.
    • A quarterly target for improvement for each measure is met (see table below) starting with 5 percent in the first quarter and increasing quarterly to 20 percent by the fourth quarter.
    • Quarterly payments to nursing facilities will be triggered by meeting these goals.
Component 3 quarterly target for improvement
Quarter Total Improvement from Baseline
1 5%
2 10%
3 15%
4 20%

In the calculation for a facility's Medicaid days, why are Medicaid hospice days not included in the numerator?

Because Medicaid hospice services are not covered under Medicaid managed care, HHSC has determined it would be inappropriate to include them in the calculation of the private nursing facility qualification percentages. Medicaid hospice is not included in the numerator for the calculation of the Medicaid percentage achievement for the individual private provider or in the numerator for the calculation of the Medicaid percentage achievement cut-off point for private providers as whole. If it were to be included in both of these calculations, the cut-off point would increase and achievement levels would increase for NFs providing Medicaid hospice services.