SECTION 353.1317. Quality Metrics for Rural Access to Primary and Preventive Services Program

(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 §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.

Source Note: The provisions of this §353.1317 adopted to be effective April 25, 2021, 46 TexReg 2717; amended to be effective May 31, 2022, 47 TexReg 3113