How will my nursing facility be assessed for performance improvements on quality metrics?
A benchmark will be set for each quality metric at the beginning of the program year as the most recent Centers for Medicare & Medicaid Services-published “national average” percentage for that measure. A nursing facility that scores better than this benchmark for any quality metric in a quarter will receive Component Two and Component Three payments for that measure. The QIPP year two benchmarks can be found here.
Alternatively, a nursing facility can earn Component Two and Three payments for a quality metric by reaching its own baseline improvement targets 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?
Each nursing facility will have four baselines 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 increase at two rates. Minimum improvement targets begin at a 1.7 percent improvement and comprise Component Two; strong improvement targets begin at a 5 percent improvement and comprise Component Three. The quarterly targets are calculated according to the charts below.
|Quarter||Total Improvement from Baseline|
|Quarter||Total Improvement from Baseline|
A nursing facility will receive Component Two payments in any quality metric for reaching its minimum improvement targets and both Component Two and Component Three payments for reaching its strong improvement targets. A nursing facility performing better than the CMS-published “national average” benchmark will receive its share of Component Two and Three funds for a quality metric whether or not it improves upon its baseline.
Does the percentage payout for Components Two and Three occur monthly or quarterly?
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.
What is the percentage payout for improvements that are made to the quality measures?
Allocation of funds across 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. Component One accounts for 110 percent of the non-federal share of program funds. Components Two and Three pay out as described below:
Minimum improvement: The total value of Component Two will be equal to 35 percent of remaining QIPP funds after accounting for Component One. A quarterly target for improvement for each measure is set, starting with 1.7 percent in the first quarter and increasing quarterly to 7 percent by the fourth quarter (see QIPP Year Two).
Strong improvement: The total value of Component Three will be equal to 65 percent of remaining QIPP funds after accounting for Component One. 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 Two).
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 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.
If the non-state-government-owned nursing 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 payment for any month in which it has at least one Medicaid day of nursing facility service.
Components Two and Three
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 Components Two and Three funds for an entire quarter even after readmitting residents.
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.
A nursing facility will be eligible for Component One payment 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 funds again. The nursing facility can then hold its Quality Assurance Performance Improvement meeting and submit the QAPI Validation report for that month.
Components Two and Three
A nursing facility must generate at least one long-stay measure from minimum data set assessments each quarter to remain eligible for Components Two and 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 Components Two and Three funds for an entire quarter even after readmitting residents.
What if my nursing facility doesn’t have data for one or more quality metrics?
If a nursing facility doesn’t produce sufficient minimum data set assessment data for one, two or three of the quality metrics, its potential share of Component Two and Three funds will be split among the remaining quality metrics. This means that missing data in one, two or three quality metrics won’t affect the total potential payout to the facility in a given quarter.
However, if a nursing facility doesn’t produce sufficient data for all four minimum data set-based quality measures, the facility will be ineligible for any Component Two or Three funds.
Any field marked “MIN DATA” on your nursing facility’s quarterly scorecard reflects a quality metric that didn’t produce sufficient data for that measure to be counted for or against the potential payout that quarter.
What does “WITHHELD” mean on my nursing facility’s quarterly scorecard?
If the exact percentage for any given 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
- 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: https://www.surveymonkey.com/r/QIPP_QAPI_Submission
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 are 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 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.