Current through Reg. 49, No. 38; September 20, 2024
(a) Introduction.
This section establishes the quality metrics that may be used in the Rural
Access to Primary and Preventive Services (RAPPS) program.
(b) Definitions. The following definitions
apply when the terms are used in this section. Other terms used in this section
may be defined in §
RSA 353.1301
of this subchapter (relating to General Provisions) or § 353.1315 of this
subchapter (relating to Rural Access to Primary and Preventive Services
Program).
(1) Baseline--An initial standard
used as a comparison against performance in each metric throughout the program
period to determine progress in a RAPPS quality metric.
(2) Benchmark--A metric-specific initial
standard set prior to the start of the program period and used as a comparison
against a rural health clinic's (RHC's) progress throughout the program
period.
(3) Measurement period--The
time period used to measure achievement of a quality metric.
(c) Quality metrics. For each
program period, the Texas Health and Human Services Commission (HHSC) will
designate quality metrics for each RAPPS capitation rate component as described
in § 353.1315(h) of this subchapter.
(1)
Each quality metric will be identified as a structure measure, improvement over
self (IOS) measure, or benchmark measure.
(2) Each quality metric will be
evidence-based.
(d)
Quality metric requirements. For each program period, HHSC will specify the
requirements that will be associated with the designated quality metric.
(1) Reporting of quality metrics. An RHC must
report all quality metrics as a condition of participation in the program. An
RHC must stratify any reported data by payor type and must report data
according to requirements published under subsection (g) of this
section.
(2) Achievement of quality
metrics.
(A) To achieve a structure measure,
an RHC must report its progress on associated activities for each measurement
period.
(B) To achieve an IOS or
benchmark measure, an RHC must meet or exceed the measure's goal for a
measurement period. Goals will be established as either a target percentage
improvement over self or performance above a benchmark as specified by the
metric and determined by HHSC. In year one of the program, providers will
establish a baseline for IOS measures.
(e) Participating RHC reporting frequency.
Participating RHCs must report quality metrics semi-annually unless otherwise
specified by the quality metric. Participating RHCs will also be required to
furnish information and data related to quality measures and performance
requirements established in accordance with subsection (f) of this section
within 30 calendar days after a request from HHSC for more
information.
(f) Notice and
hearing.
(1) HHSC will publish notice of the
proposed quality metrics and their associated requirements no later than
January 31, preceding the first month of the program period. The notice must be
published either by publication on HHSC's website or in the
Texas
Register. The notice required under this section will include the
following:
(A) instructions for interested
parties to submit written comments to HHSC regarding the proposed metrics and
requirements; and
(B) the date,
time, and location of a public hearing.
(2) Written comments will be accepted for 15
business days following publication. There will also be a public hearing within
that 15-day period to allow interested persons to present comments on the
proposed metrics and requirements.
(g) Publication of final metrics and
requirements. Final quality metrics and requirements will be provided through
HHSC's website on or before February 28 of the calendar year that also contains
the first month of the program period. If the Centers for Medicare and Medicaid
Services requires changes to quality metrics or requirements after February 28,
HHSC will provide notice of the changes through HHSC's website.
(h) Evaluation Reports.
(1) HHSC will evaluate the success of the
program based on a review of reported metrics. HHSC may publish more detailed
information about specific performance of various participating RHCs, classes
of RHCs, or service delivery areas.
(2) HHSC will publish interim evaluation
findings regarding the degree to which the arrangement advanced the established
goal and objectives of each capitation rate component.
(3) HHSC will publish a final evaluation
report within 270 days of the conclusion of the program period.
