Is the Quality Incentive Payment Program written into state rule?
Yes. Rules that cover the QIPP are located in 1 TAC §353.1301 - 353.1304.
- 1 TAC §353.1301 generally applies to delivery system and provider payment initiatives.
- 1 TAC §353.1302 applies to the QIPP on or after September 1, 2019.
- 1 TAC §353.1303 applies to the QIPP before September 1, 2019.
- 1 TAC §353.1304 specifies quality metrics for the QIPP on or after September 1, 2019.
How will my nursing facility be assessed for performance improvements on quality metrics?
Performance improvements are assessed for all metrics of Component Three and Metrics 1 and 2 of Component Four. For these measures, a benchmark will be set for each quality metric at the beginning of the program year using the most recent Centers for Medicare & Medicaid Services-published “national average” percentage for that measure. A nursing facility that scores equal to or better than this benchmark for any quality metric in a quarter will receive payment for these metrics. The QIPP Year Three benchmarks can be found here.
Alternatively, a nursing facility can earn payments for any metric of Component Three and Metric 1 of Component Four by reaching its own baseline improvement target in a quarter, whether or not it performs better than the national average benchmark for that measure.
How are my nursing facility’s baselines and improvement targets determined for CMS quality measures?
Each nursing facility will have a baseline calculated at the beginning of the program year, one for each of the four CMS quality measures. Each baseline will be an average of that nursing facility’s most recently published four quarters of CMS data for that quality metric. Quarterly targets will then be calculated as percent improvements on these initial baselines, which don’t change during a program year.
Baseline improvement targets begin at a 5 percent improvement. The quarterly targets are calculated according to the chart below.
|Quarter||Total Improvement from Baseline|
|Quarter||Total Improvement from Baseline|
A nursing facility will receive payments for any quality metric when its improvement target or the CMS-published "national average" benchmark is reached. Note that if a facility performs better than the national average benchmark, a facility will receive its share of funds for a quality metric whether or not it improves upon its baseline.
When are the components paid, monthly or quarterly?
Components One and Two are paid monthly, and Components Three and Four are paid quarterly.
What components is my facility eligible to receive?
Components Two and Three are available to all NFs enrolled in QIPP, including those that are privately owned. Components One and Four are only available to NFs enrolled in QIPP with non-state government-owned partnerships. All facilities must meet program requirements within each component in order to receive funds.
Will nursing facilities participating in QIPP need to contract with one MCO or several MCOs?
Nursing facilities should contract with all of the MCOs in their service delivery area.
Some MCOs have needed to contract with facilities outside of their SDAs. If you have questions about these exceptions, please contact QIPP staff at QIPP@hhsc.state.tx.us.
How are program funds allocated across the components?
Allocation of funds to qualifying non-state government-owned and private nursing facilities will be based upon historical Medicaid days of nursing facility service. The maximum amount of funds available is recalculated every six months.
The total value of Component One will be equal to 100 percent of the non-federal share of the QIPP.
The total value of Component Two will be equal to 30 percent of remaining QIPP funds after accounting for the funding of Component One and Component Four.
The total value of Component Three will be equal to 70 percent of remaining QIPP funds after accounting for the funding of Component One and Component Four. A quarterly target for improvement for each measure is set, starting with 5 percent in the first quarter and increasing quarterly to 20 percent by the fourth quarter (see QIPP Year Three).
The total value of Component Four will be equal to 16 percent of the funds of the QIPP.
In the calculation of 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 cutoff point for private providers as a whole. If it were to be included in both of these calculations, the cutoff point would increase and achievement levels would increase for nursing facilities providing Medicaid hospice services.
I am planning to temporarily close my nursing facility for remodeling. Does the nursing facility still qualify for QIPP payments?
QIPP payments are tied to Medicaid use, meaning the nursing facility must be serving residents to be eligible.
Component One and Two
If the facility closes and transfers its residents, it becomes ineligible for payment for any month in which it has zero Medicaid days of nursing facility service. The nursing facility is eligible for Component One and Two payments for any month in which it has at least one Medicaid day of nursing facility service.
Eligibility for payments depends on when minimum data set data were last transmitted for the residents. Nursing facilities must maintain at least one long-stay quality measure derived from minimum data set assessments for the quarter. After a temporary closing in which the nursing facility is not serving residents for more than 30 days, readmitted residents will have to stay 100 cumulative days before their minimum data set assessments will again generate "long-stay" data needed for payment eligibility in that quarter. This means a nursing facility can remain ineligible for Component Three funds for an entire quarter even after readmitting residents.
As with all Components, a facility must have at least one Medicaid day of nursing facility service in the quarter to remain eligible for payments. If “long-stay” data are not available for the minimum data set quality measure as described above, the facility remains eligible for all Component funds so long as it has at least one Medicaid day of service. In such cases, earned payments will be determined by the status of the remaining quality measures in the Component.
My residents have been recently readmitted to the facility after having been served by other facilities. Will I receive payments through the QIPP program?
QIPP payments are tied to Medicaid utilization and long-stay CMS Five-Star quality metrics, meaning nursing facilities must be serving residents and generating long-stay minimum data set assessment data to remain eligible for all potential payments.
Components One and Two
A nursing facility will be eligible for Components One and Two payments for any month in which it provides nursing facility services to at least one Medicaid beneficiary on at least one day of the month. As soon as residents are readmitted to the facility, it becomes eligible for Component 1 and 2 funds again. The nursing facility can then hold its Quality Assurance Performance Improvement meeting and submit the QAPI Validation report for that month, and it can then provide data related to workforce development (including RN hours) by the next submission deadline.
A nursing facility must generate at least one long-stay measure from minimum data set assessments each quarter to remain eligible for Component Three payments. Any resident who remains discharged from a facility for more than 30 days will no longer generate long-stay data after readmission. The resident would have to stay in the nursing facility for at least 100 cumulative days to be counted as a "long-stay" resident and generate the quality measure data needed for payment eligibility in that quarter. This means a nursing facility can remain ineligible for Component Three funds for an entire quarter even after readmitting residents.
If a re-opened facility has at least one Medicaid day of nursing facility service in the quarter but has not yet generated the long-stay quality measure derived from minimum data set assessments, the facility can be eligible for all Component Four funds. In such cases, earned payments will be determined by the status of the remaining quality measures in the Component.
What if my nursing facility doesn’t have data for one or more quality metrics?
If a nursing facility does not produce sufficient minimum data set assessment data for one or two CMS five-star quality metrics within Components Three and Four, its potential share of component funds will be split among the remaining quality metrics. This means that missing data in one or two minimum data set quality metrics within a component will not affect the total potential payout to the facility in a given month or quarter.
However, if a nursing facility does not produce sufficient data for all quality metrics within a component, the facility will be ineligible for any funds for that component.
Any field marked “MIN DATA” on your nursing facility’s quarterly scorecard reflects a minimum data set quality metric that did not produce sufficient data for that measure to be counted for or against the potential payout that quarter.
This allowance does not hold true for self-reported data. If a facility does not submit sufficient data for any measure relying on self-reported data, the measure is considered “not met” and will count against the total payment for the related Component.
What does “WITHHELD” mean on my nursing facility’s quarterly scorecard?
If the exact percentage for any given CMS Five-Star quality measure reflects data from only a small number of people, Health Insurance Portability and Accountability requirements prohibit HHSC from publishing those numbers in shared documents such as the QIPP quarterly scorecard. You can contact HHSC to receive any quality metric percentages redacted from the scorecard.
Quality measures marked “WITHHELD” still affect potential payout for the quarter. While the exact percentage is not published, that quality metric is counted as “met” or “not met” for the purposes of calculating the quarterly payment to the nursing facility.
How can I receive alerts regarding the QIPP program?
You may sign up for QIPP emails through GovDelivery at https://public.govdelivery.com/accounts/txhhsc/subscriber/new.
Type in your email and submit, and then you will be prompted to select the email updates you wish to receive.
For QIPP-related updates, select the following options under Long-term Care Providers: Nursing Facility Resources, Provider Alerts.
You might also wish to look through the other options to see if there are other alerts that could be of assistance to you.
Quality Assurance Performance Improvement FAQs
What should the title of my QAPI Validation Report form file include?
The title of the QAPI Validation Report form file must include the following:
- Facility name and Facility ID Number
- Month and year the QAPI meeting took place
Example: Stoneybrook Manor September 2018
Where should I submit the QAPI Validation Report forms?
Completed forms are submitted each month through a Web portal available here: http://registration.hhsc.state.tx.us/qipp_app/qipp_app/default.aspx
What is the due date of my monthly QAPI Validation Report form?
The monthly QAPI Validation Report form is due by close of business no later than the first business day following the end of the month being reported. For example, November 2018 QAPI Validation Report forms were due to HHSC no later than close of business on Dec. 3, 2018.
Where can I send questions related to QAPI?
Send questions regarding the QAPI form, requirements or overall submission process to: MCS_QIPP_QAPI@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 happens if HHSC does not 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.
What is a QIPP Scorecard?
QIPP Scorecards are created by the HHSC Rate Analysis department as a tool for reporting component results and payment information. The Scorecard provides facilities a single source for viewing their component targets, metric results, component capitation rates, and monthly and quarterly payments. The Scorecards also provide the Managed Care Organizations the calculated payments to be made to facilities based on their performance factors.
How do I read the Scorecard?
The Scorecard is broken down into multiple worksheets. The “QIPP Scorecard” worksheet provides individual facilities with component targets, metric results, component capitation rates, and earned funds. The “QIPP Breakout” provides a more detailed view of what the facility earned in each component. The “Payments” worksheet shows how much the MCO should pay the facility. For further instructions, view the NF Provider Webinar Slides (PDF).
When and how will I receive my Scorecard?
Scorecards are published to the HHSC Rate Analysis QIPP website towards the middle of the month. Providers and stakeholders receive an email alerting them when the Scorecard has posted.
When and how will I receive payments?
Payments to Nursing Facilities are made through their contracted MCOs. The MCO has 20 days after receipt of the Scorecard to distribute payments to their contracted facilities.
What timeframe does the Scorecard cover?
The Quality Incentive Payment Program eligibility period coincides with the State Fiscal Year from September 1st to August 31st. Scorecards are created on a monthly and quarterly basis as well as for three adjustment periods following the eligibility period. For QIPP Year 3, the quarterly and adjustment Scorecards are as follows:
- Quarter 1: September – November 2019
- Quarter 2: December 2019 – February 2020
- Quarter 3: March – May 2020
- Quarter 4: June – August 2020
- Adjustment Period 1: September – December 2020
- Adjustment Period 2: January – August 2021
- Adjustment Period 3: September 2021 – July 2022
If I have a question about the Scorecard, who do I contact?
You may email questions to QIPP@hhsc.state.tx.us.