THCA Notes

Volume XXXII, Number 1
January 2017

QIPP Alert to Nursing Facility Providers

Update on the Texas Quality Incentive Payment Program (QIPP) for Nursing Facilities Change of Ownership (CHOW) Notice:

A nursing facility (NF) that is interested in participating in QIPP as a non-state government-owned NF must be a non-state government-owned NF with a Medicaid contract effective date of April 1, 2017, or earlier. A NF that is not currently a non-state government-owned NF that is interested in pursuing a Change of Ownership (CHOW) from private ownership to public ownership, as a part of obtaining QIPP funds, should be aware of the following information:

A completed CHOW application will be due to the Texas Department of Aging and Disability Services (DADS) no later than March 2, 2017; and
All required documentation pertaining to the CHOW will be due by March 31, 2017.

For information related to the CHOW requirements, visit https://hhs.texas.gov/node/2858.

For private nursing facilities that are interested in participating in QIPP, it is important to note that the facility must have a percentage of Medicaid NF days of service that is greater than or equal to the private NF QIPP eligibility cut-off point, which will be equal to the mean percentage of historical Medicaid NF days of service provided under fee-for-service (FFS) and managed care (MC) by all private NFs plus one standard deviation, as determined by HHSC. The private NF QIPP eligibility period cut-off point is 77.8% for the first QIPP year is based on the 2014 cost report. For each private NF, the percentage of Medicaid NF days is calculated by summing the NF’s Medicaid NF fee-for-service and MC days of service and dividing that sum by the NF’s total days of service in all licensed beds. Medicaid hospice days of service are included in the denominator but excluded from the numerator.

Data sources for the determination of each private NF’s QIPP eligibility status are listed in priority order below:

The most recently available, audited Medicaid NF cost report for the private NF;
The most recently available, audited Medicaid Direct Care Staff Rate Staffing and Compensation Report for the private NF;
The most recently available, audited Medicaid NF cost report for the immediately prior owner of the private NF; and
The most recently available, audited Medicaid Direct Care Staff Rate Staffing and Compensation Report for the immediately prior owner of the private NF.

If none of these data sources are available, the private NF is not eligible for participation in QIPP.

If you have any questions related to QIPP or the CHOW process, please send your questions to QIPP@hhsc.state.tx.us.