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The Texas Health and Human Services Commission (HHSC) is providing guidance for nursing facilities (NF) participating in the Quality Incentive Payment Program (QIPP) related to Changes of Ownership (CHOW) for program years 5 (SFY2022) and 6 (SFY2023).
Changes of Ownership
NFs changing ownership to a new class of facility are a member of the new class retroactive to the effective date of the CHOW, following HHSC CHOW approval. NFs must meet eligibility requirements for the new facility class beginning with the effective date of the change. If a NF changes ownership to become a non-state government owned (NSGO) NF, the conditions of participation reporting requirements under Component 1 will become effective upon the final HHSC approval of the CHOW.
Conditions of Participation
As a condition of participation, all NFs participating in QIPP must report all quality data denoted as required. A facility must submit the information necessary for HHSC to evaluate if the program is advancing the quality goal or strategy. If the NF does not submit a complete performance improvement project (PIP) template or attest to whether the NF held the monthly Quality Assurance and Performance Improvement (QAPI) meetings, as outlined below, HHSC will follow up to provide an opportunity for the provider to meet the reporting requirements. If the NF still fails to submit within timelines communicated by HHSC, the NF will be removed from the program and all payments will be recouped.
Conditions of participation apply to the following components:
Component 1
- Facility holds a QAPI meeting each month that accords with quarterly federal and state requirements and pursues specific outcomes developed by the NF as part of a focused PIP. This metric entails an attestation by the facility administrator or authorized staff to whether a monthly meeting was held that incorporates all goals set forth for QAPI development by CMS.
Component 2
- Metric 3: NF has a workforce development program in the form of a PIP that includes a self-directed plan and monitoring outcomes. NF completes the PIP reporting template with appropriate information on PIP implementation.
The full details of what CMS approved for SFY2022 can be found in Quality Metrics and Performance Requirements (PDF).
A NF that fails to meet a condition of participation will be removed from the program retroactive to the first day of the program period. HHSC will redistribute revenue paid to facilities removed from the program to the remaining facilities participating in the program period. Facilities that meet the conditions of participation will remain enrolled in the program period.
Option to Decline Payment
A facility may optionally notify HHSC that it wishes to decline revenue from a component of QIPP at any time. If a facility notifies HHSC that it wishes to decline payment for a component or components, HHSC will remove the facility from consideration of the component when allocating revenues associated with that component.
For example, if a NSGO facility determines that it does not wish to receive funds from Component 1, HHSC will not include the days of that facility when calculating the interim distribution of QIPP payments in the scorecard, nor will HHSC consider the days of that facility when conducting post-program period reconciliations. This opt-out applies only to the receipt of funds, not to the requirement to meet Conditions of Participation.
This is a distinct process from how HHSC will consider revenues that are associated with components wherein payments are based on measure achievement. In those circumstances, revenue that would have been designated for the facility in the component will be entered into non-dispersed funds and distributed across qualifying QIPP participants based on each NF’s proportion of total earned QIPP funds by component.
For more information, please visit the Provider Finance QIPP website.
If your facility wishes to decline revenue for a QIPP component(s), please email QIPP@hhs.texas.gov.