The Quality Incentive Payment Program (QIPP) is a state directed payment program (DPP) for Texas nursing facilities serving residents enrolled in the STAR+PLUS Medicaid managed care program. The program must be approved annually by the Centers for Medicaid and Medicare Services (CMS) for each State Fiscal Year (SFY). Providers earn payments for meeting participation and performance requirements across four components.
QIPP Year 5 (Y5) Performance Requirements
QIPP SFY 2022 Quality Metric Packet (PDF): This document lists the final quality metrics and performance requirements. (Updated 11/17/2021)
QIPP SFY 2022 Technical Specifications (PDF): This document includes a list of new and updated QIPP performance measures with instructions on data collection and guidelines for use of templates and submission using the QIPP Data Portal. (Updated 11/17/2021)
Final performance requirements for QIPP Year 5, reporting templates, timelines and other provider resources are available on the QIPP Resources webpage.
QIPP SFY 2022 (Y5)
HHSC conducted a public hearing on Jan. 15, 2021 to allow public comments on the proposed quality metrics and their associated performance requirements for QIPP Y5. The Centers for Medicaid and Medicare Services (CMS) approved QIPP for Y5 in November 2021. The final pool size for the program year has been set at $1.1 billion.
QIPP SFY 2021 (Y4)
For QIPP Y4 (Sept. 1, 2020 to Aug. 31, 2021), funds were paid through four components of the STAR+PLUS nursing facility managed care per member per month capitation rates. The budget for SFY 2021 was $1.1 billion.
QIPP SFY 2020 (Y3)
For QIPP Y3 (Sept. 1, 2019 to Aug. 31, 2020) funds were paid through four components of the STAR+PLUS nursing facility managed care per member per month capitation rates. HHSC adopted a new component structure and set of quality metrics beginning Y3. The budget for SFY2020 was $600 million.
QIPP SFY 2018 (Y1) and SFY 2019 (Y2)
For both QIPP Y1 (Sept. 1, 2017 to Aug. 31, 2018) and Y2 (Sept. 1, 2018 to Aug. 31, 2019), funds were paid through three components of the STAR+PLUS nursing facility managed care per member per month capitation rates. The budget for QIPP Y1 was $399,333,542. The budget for QIPP Y2 was $446 million.
Both QIPP Y1 and Y2 had the following components:
Component One was exclusively available to non-state government-owned (NSGO) NFs and was triggered by the nursing facility’s submission of a monthly Quality Assurance Performance Improvement Validation Report.
Components Two and Three were available to all participating QIPP facilities and were triggered by meeting the national benchmark or by demonstrating minimum improvement (Component Two) or strong improvement (Component Three) on the following CMS long-stay nursing facility quality metrics:
- High-risk long-stay residents with pressure ulcers.
- Percent of residents who received an antipsychotic medication.
- Residents experiencing one or more falls with major injury.
- Residents who were physically restrained.
Performance and Reporting Requirement Adjustments Due to COVID-19
QIPP Y3 and Y4 were impacted by the COVID-19 Public Health Emergency (PHE). The CMS waived certain reporting requirements for nursing facilities effective March 1, 2020, including timeframe requirements for Minimum Data Set (MDS) assessments and transmission.
- On June 9, 2020 HHSC waived the performance requirements connected to all MDS quality measures effective March 1, 2020 to Aug. 31, 2020. To help relieve the administrative burden on facilities, reporting requirement for Component One-Submission of monthly Quality Assurance and Performance Improvement Validation reports was also waived.
- On Dec. 23, 2020, HHSC extended the waiver effective Sept. 1, 2020, to the rest of fiscal year 2021.
- CMS reinstated MDS reporting requirements effective May 10, 2021. HHSC reinstated performance requirements for the fourth quarter of QIPP Y4, spanning June 1, 2021 to Aug. 31, 2021.
During both waivers, while HHSC suspended the reporting requirements for Component One, NSGOs were required to continue holding monthly Quality Assurance and Performance Improvement (QAPI) meetings. If a facility was randomly selected for a Quality Assurance (QA) review, HHSC reserved the rights to require supporting documentation for all monthly meetings.
QIPP Y3 funds dedicated to Component Three were disbursed in monthly payments to all enrolled NFs to support responses to COVID-19, such as workforce recruitment and retention and infection control. The changes to the Component Three payment schedule were implemented from the May 2020 and included retroactive Component Three payments for March and April 2020.
The changes to QIPP Y4 payment schedule for Component Three was reflected in the December 2020 scorecard and included all retroactive Component payments for September through November 2020. The adjustments continued through the first three quarters of Year Four but were reinstated in the final quarter of QIPP Y4.
QIPP Program History, Rules and Regulations
During the 83rd Session, the Texas Legislature outlined its goals for the Medicaid managed care carve-in of NFs. In implementing the NF carve-in, HHSC was directed to encourage transformative efforts in the delivery of NF services, including "efforts to promote a resident-centered care culture through facility design and services provided" (Senate Bill 7, 83rd Texas Legislature, Regular Session, 2013).HHSC adopted the Minimum Payment Amount Program (MPAP) in 2015, a short-term program that would transition to a performance-based initiative. MPAP established minimum payment amounts for qualified nursing facilities in STAR+PLUS. The General Appropriations Act for the 2016-2017 biennium contained the HHSC Budget Rider 97, which directed HHSC to transition the MPAP to QIPP.
QIPP is governed by the following Texas Administrative Code (TAC) Rules:
Federal regulatory authority governing QIPP as a state directed payment program is contained in the 42 CFR §438.6(c).