Current through Reg. 49, No. 38; September 20, 2024
(a) Introduction.
This section establishes the quality metrics and required reporting that may be
used in the Directed Payment Program for Behavioral Health Services.
(b) Definitions. The following definitions
apply when the terms are used in this section. Terms that are used in this
section may be defined in §353.1301 (relating to General Provisions) or
§ 353.1320(relating to Directed Payment Program for Behavioral Health
Services) of this subchapter.
(1)
Baseline--An initial standard used as a comparison against performance in each
metric throughout the program period to determine progress in the program's
quality metrics.
(2) Benchmark--A
metric-specific initial standard set prior to the start of the program period
and used as a comparison against a provider'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 of the program's capitation rate components
as described in § 353.1320(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 and will be presented to the public for comment in
accordance with subsection (e) of this section.
(d) Quality Metric requirements. For each
program period, HHSC will specify the requirements that will be associated with
the designated quality metric that is expected to advance at least one of the
goals and objectives in the Medicaid quality strategy. Quality metric data will
be used to evaluate the degree to which the arrangement advances at least one
of the goals and objectives that are incentivized by the payments described
under § 353.1320(h) of this subchapter.
(1) Reporting of quality metrics. All quality
metrics must be reported as a condition of participation in the program.
Participating providers must stratify any reported data by payor type and must
report data according to requirements published under subsection (f) of this
section.
(2) Reporting frequency.
Providers must report quality metrics semi-annually, unless otherwise specified
by the metric. Participating providers will also be required to furnish
information and data related to quality measures and performance requirements
established in accordance with subsection (e) of this section within 30
calendar days after a request from HHSC for more information.
(3) Other metrics related to improving the
quality of care for Texas Medicaid beneficiaries. If HHSC develops additional
metrics for inclusion in the Directed Payment Program for Behavioral Health
Services, the associated performance requirements will be presented to the
public for comment in accordance with subsection (e) of this section.
(e) 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.
(f) 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
of the calendar year, HHSC will provide notice of the changes through HHSC's
website.
(g) Evaluation Reports.
(1) HHSC will evaluate the success of the
program based on a statewide review of reported metrics. HHSC may publish more
detailed information about specific performance of various participating
providers, classes of providers, 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.
