Nursing Facility Minimum Performance Standards

Measures and Benchmarks

As required by House Bill (HB) 2658, 87th Legislature, Regular Session, 2021, HHSC has adopted rules and established the Minimum Performance Standards (MPS) for NFs that participate in STAR+PLUS. Information on the Minimum Performance Standards, and benchmarks, is provided below.

The Centers for Medicare & Medicaid Services (CMS) collect multiple long-stay measures. Five of those measures comprise the STAR+PLUS nursing facility (NF) minimum performance standards (MPS) and are listed in Table 1: Benchmarks for CY 2022 and 2023. HHSC will evaluate each NF’s four-quarter average on each measure to determine if they did not meet, met, or exceeded the benchmark.

The data for evaluating MPS will be available each spring. HHSC will pull the previous calendar year’s data, analyze, and assess performance. The results for STAR+PLUS NF MPS will be available annually in July.

Table 1: Benchmarks for CY 2022 and 2023

CMS Long-Stay Measures2022-2023 BenchmarksPerformance Requirement to Meet the MPS
N028.02 Percent of long-stay residents whose need for help with activities of daily living has increased30%At or Below 30%
N015.03 Percent of high-risk residents with pressure ulcers17%At or Below 17%
N016.03 Percent of residents assessed and appropriately given the seasonal influenza vaccine77%At or Above 77%
N020.02 Percent of residents assessed and appropriately given the pneumococcal vaccine80%At or Above 80%
N035.03 Percent of residents whose ability to move independently worsened31%At or Below 31%

MCOs

The MCO will be required to adhere to STAR+PLUS Uniform Managed Care Manual requirements in chapters 8.6 – State Mandated Requirements for STAR+PLUS Nursing Facility Providers (PDF) and 8.11 – STAR + PLUS Nursing Facility Minimum Performance Standards (PDF), and may refuse to contract with a NF seeking to participate in or renew a contract for STAR+PLUS, if the NF does not meet the minimum performance standards (under certain conditions).

Minimum Performance Standards – Calendar Year 2023 Results

HHSC Minimum Performance Standards – Facility Specific Performance 2023 (PDF). The final data reflects nursing facility-specific performance on HHSC-established benchmarks (met/failed) for the following MPS long-stay quality measures in calendar year 2023.

  • N016.03 Percent of residents assessed and appropriately given the seasonal influenza vaccine
  • N020.02 Percent of residents assessed and appropriately given the pneumococcal vaccine

Quality measure performance was derived from the minimum data set (MDS) four-quarter average made available on April 25, 2024, by CMS on Nursing Home Compare (NHC).

In October 2023, CMS froze data collection for three of the MPS measures:

  • N015.03 Percent of high-risk residents with pressure ulcers
  • N028.02 Percent of long-stay residents whose need for help with activities of daily living has increased
  • N035.03 Percent of residents whose ability to move independently worsened

As a result, data for these measures were only available for the first three quarters of CY 2023. HHSC is not publishing facility-specific performance for these measures, since four-quarter weighted averages are not available. 

HHSC Minimum Performance Standards – Aggregate Number of Providers Failing 1 to 5 Benchmarks 2023 (PDF). The final data reflects the aggregate number of providers that failed one, two, three, four, and five benchmarks. This includes all MPS measures, including the measures that were frozen by CMS.

HHSC Minimum Performance Standards – Performance All Providers: Aggregate Number and Percentage of Providers that Met/Failed Benchmarks 2023 (PDF). The final data reflects the aggregate number and percentage of providers that met/failed HHSC-established performance benchmarks, as identified in the HHSC Minimum Performance Standard Results. This includes all MPS measures, including the measures that were frozen by CMS.

MPS Resources

HHS has developed the following toolkits as resources for NFs. The information contained in each toolkit is evidence-based and can be used by facilities to improve their systems in these areas:

Influenza Vaccination (PDF)

Pneumococcal Vaccinations (PDF)

Maintaining Independence and Assisting with Activities of Daily Living (ADLs) (PDF)

Maintaining Independence and Assisting with Activities of Daily Living (ADLs): Mobility or Locomotion on the Unit (PDF)

Prevention and Management of High-Risk Pressure Ulcers/Injuries (PDF)