QIPP Overview and History

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 & Medicare Services (CMS) for each State Fiscal Year (SFY). Providers earn payments for meeting participation and performance requirements across four components.

Program History

During the 83rd legislative session, Texas lawmakers outlined goals for the Medicaid managed care carve-in of nursing facilities. In implementing the nursing facilities carve-in, HHSC was directed to encourage transformative efforts in the delivery of nursing facilities 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.

Program Payments and Financial Structure

Visit the QIPP Provider Finance Department for more information about Program-year specific information on:

  • Nursing facility eligibility and enrollment.
  • Estimated Component Values and Suggested inter-governmental transfer (IGT).
  • Changes of ownership (CHOW).
  • Published scorecards for incentive payments, and quality metric targets.
  • Quick reference for due dates throughout the program

SFY 2024 (Y7)

CMS approved QIPP for Year 7 on July 30, 2023, setting the final pool size for the program year at $1.1 billion.

QIPP SFY 2023 (Year 6)

CMS approved QIPP for Year 6 on Aug. 1, 2022, setting the final pool size for the program year at $1.1 billion.

QIPP SFY 2022 (Year 5)

CMS approved QIPP for Year 5 in November 2021, setting the final pool size for the program year at $1.1 billion.

Infection Control Templates and Toolkits

Expanding on requirements included in QIPP Years 3 and 4, HHSC required nursing facilities participating in QIPP Years 5-7 to collect audit data for each month within the program year and report cumulative summaries to HHSC twice a year.

QIPP SFY 2021 (Year 4)

For QIPP Year 4 (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. CMS set the SFY 2021 budget at $1.1 billion.

QIPP SFY 2020 (Year 3)

For QIPP Year 3 (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 Year 3. CMS set the SFY 2020 budget at $600 million.

Performance and Reporting Requirement Adjustments Due to COVID-19

The COVID-19 public health emergency (PHE) impacted QIPP years 3 and 4. 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, HHSC waived the reporting requirement for Component 1 (submission of monthly Quality Assurance and Performance Improvement Validation reports).
  • 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 Year 4 spanning June 1, 2021, to Aug. 31, 2021.

During both waivers, while HHSC suspended the reporting requirements for Component 1, 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 right to require supporting documentation for all monthly meetings.

QIPP Year 3 funds dedicated to Component 3 were disbursed in monthly payments to all enrolled nursing facilities to support responses to COVID-19, such as workforce recruitment and retention and infection control. Changes to the Component 3 payment schedule were implemented from May 2020 and included retroactive Component Three payments for March and April 2020.

The changes to the QIPP Year 4 payment schedule for Component 3 were reflected in the December 2020 scorecard and included all retroactive component payments for September 2020 through November 2020. The adjustments continued through the first three quarters of Year 4 but were reinstated in the final quarter of QIPP Year 4.

QIPP SFY 2019 (Year 2) and SFY 2018 (Year 1)

For both QIPP Y2 (Sept. 1, 2018, to Aug. 31, 2019) and Y1 (Sept. 1, 2017, to Aug. 31, 2018), funds were paid through three components of the STAR+PLUS nursing facility managed care per member per month capitation rates. CMS set the QIPP Year 2 budget at $446 million and QIPP Year 1 budget at $399 million.

Both QIPP years 1 and 2 had the following components:

Component 1 was exclusively available to non-state government-owned (NSGO) nursing facilities and was triggered by their submitting a monthly Quality Assurance Performance Improvement Validation Report.

Components 2 and 3 were available to all participating QIPP facilities and triggered by meeting the national benchmark or by demonstrating minimum improvement (Component 2) or strong improvement (Component 3) on the following CMS long-stay nursing facility quality metrics:

  • High-risk long-stay residents with pressure ulcers.
  • Percentage of residents who received an antipsychotic medication.
  • Residents experiencing one or more falls with major injury.
  • Residents who were physically restrained.