Texas Administrative Code
Title 1 - ADMINISTRATION
Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION
Chapter 353 - MEDICAID MANAGED CARE
Subchapter G - STAR+PLUS
Section 353.610 - Minimum Performance Standards for Nursing Facilities that Participate in the STAR+PLUS Program
Universal Citation: 1 TX Admin Code ยง 353.610
Current through Reg. 49, No. 38; September 20, 2024
(a) Purpose. The purpose of this section is to establish minimum performance standards applicable to nursing facility providers that participate in the STAR+PLUS program.
(b) Definitions. The following words and terms, when used in this section, have the following meanings, unless the context clearly indicates otherwise:
(1) CMS--Centers for Medicare & Medicaid
Services. The federal agency responsible for administering Medicare and
overseeing state administration of Medicaid.
(2) Corrective actions--Actions taken for the
purpose of correcting undesirable clinical performance; may also be called a
corrective action plan or a performance improvement plan (PIP).
(3) HHSC--The Texas Health and Human Services
Commission or its designee.
(4)
Long stay quality measure--The CMS long stay quality measure specifications are
based on nursing home (NH) residents whose episode is greater than or equal to
101 cumulative days in the NH at the end of the target period.
(5) MDS--Minimum data set. A federally
mandated standardized clinical assessment of all residents in certified nursing
facilities.
(6) Minimum performance
standards--Standards applicable to a nursing facility that participates in the
STAR+PLUS program that represent the minimal clinical performance expected,
based on evidence-based guidelines and analysis.
(7) Nursing facility--A convalescent or
nursing home or related institution licensed under Health and Safety Code
Chapter 242, that provides long-term services and supports to recipients and
that participates in the STAR+PLUS program.
(8) STAR+PLUS Managed Care Organization--An
organization under contract with HHSC to manage delivery of Medicaid services
to members in the STAR+PLUS program.
(9) STAR+PLUS Program--This term has the
meaning set forth in §354.4003 of the title (relating to
Definitions).
(c) HHSC establishment and monitoring of minimum performance standards.
(1) HHSC establishes the following CMS
nursing facility long stay quality measures from the MDS and associated HHSC
benchmarks as the minimum performance standards for evaluating the performance
of a nursing facility:
(A) N028.02 Percent of
residents whose need for help with activities of daily living has increased.
The benchmark is 30%. Nursing facilities do not meet the benchmark if HHSC
determines that more than 30% of residents have an increased need for help with
activities of daily living.
(B)
N015.03 Percent of high-risk residents with pressure ulcers. The benchmark is
17%. Nursing facilities do not meet the benchmark if HHSC determines that more
than 17% of high-risk residents have pressure ulcers.
(C) N016.03 Percent of residents assessed and
appropriately given the seasonal influenza vaccine. The benchmark is 77%.
Nursing facilities do not meet the benchmark if HHSC determines that less than
77% of residents were assessed and appropriately given the seasonal influenza
vaccine.
(D) N020.02 Percent of
residents assessed and appropriately given the pneumococcal vaccine. The
benchmark is 80%. Nursing facilities do not meet the benchmark if HHSC
determines that less than 80% of residents were assessed and appropriately
given the pneumococcal vaccine.
(E)
N035.03 Percent of residents whose ability to move independently worsened. The
benchmark is 31%. Nursing facilities do not meet the benchmark if HHSC
determines that more than 31% of residents have a worsened ability to move
independently.
(2) HHSC
compares the performance of a nursing facility on each of the minimum
performance standard measures listed in paragraph (1) of this subsection to the
associated HHSC benchmarks to determine if a facility meets or does not meet
the required minimum performance standards.
(3) HHSC makes the minimum performance
standard measures and the associated HHSC benchmarks available on the HHSC
website.
(4) HHSC monitors the
performance of a nursing facility on an annual basis in accordance with the
minimum performance standard measures and the associated HHSC
benchmarks.
(5) HHSC may require a
nursing facility that does not meet the minimum performance standard benchmarks
to take corrective actions.
(6)
HHSC monitors a nursing facility that has been required to initiate corrective
actions in accordance with the minimum performance standard measures and the
associated HHSC benchmarks and follows up with the nursing facility regarding
its performance, as appropriate.
(d) HHSC coordination with Medicaid Managed Care Organizations (MCOs).
(1) HHSC shares
minimum performance standards data results with STAR+PLUS MCOs, as
appropriate.
(2) STAR+PLUS MCOs may
act on the data, as appropriate.
Disclaimer: These regulations may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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