What QIPP is
The Quality Incentive Payment Program is run by Texas HHSC under 1 TAC §353.1302 and paid through the STAR+PLUS managed-care organizations. It's the only Texas Medicaid quality payment for nursing facilities, so “Texas QIP” and “the QM program” usually mean QIPP.
Government-owned buildings (NSGO, typically a hospital-district license holder) can earn all four components. Private buildings can earn two, and only with at least 65% Medicaid days.
The four components
| Component | Share | Who | What it measures |
|---|---|---|---|
| 1 | 44% | NSGO | Falls with major injury, UTI, weight loss, antipsychotic use, walking worsened. Texas mean benchmark. |
| 2 | 20% | All | PBJ staffing hours per resident day: CNA, licensed and total nurse. National benchmark. |
| 3 | 20% | All | Depressive symptoms, antianxiety or hypnotic use, new or worsened bowel or bladder. National benchmark. |
| 4 | 16% | NSGO | Pressure ulcers and catheters. Texas mean benchmark. |
Component 1 pays in full with two metrics met, and 90% with one. Components 2, 3 and 4 pay the share of their metrics that were met. HHSC adjusts these release rules from year to year, so check the year's rules before planning around them.
How each target is set
Every metric has a baseline, fixed for the year from the prior calendar year. What happens next depends on which side of the benchmark the baseline sits:
- Worse than the benchmark: the target tightens every quarter. MDS measures must improve 5%, 10%, 15% and 20% on the baseline in quarters 1 to 4; staffing must rise 1% to 4%. A building holding its rate perfectly flat can pass in the first quarter and miss in the third.
- At or better than the benchmark: a maintenance band. Stay within 2.0 points of your baseline (and no worse than the benchmark) on an MDS measure, or within 2% on staffing.
Each quarter is scored on that single calendar quarter's published rate, not a four-quarter average. On a 50-resident measure, one resident is 2 points: the whole width of the maintenance band.
When CMS suppresses a metric for too few residents it doesn't count against you, but if every metric in a component is suppressed, that component pays nothing.
How the money works
QIPP is not a flat rate. HHSC splits a fixed pool, $1,686,562,500 a year after the MCO deductions, across components, and each building's share is weighted by its Medicaid days. The value HHSC publishes per building is an estimate; the MCO pays per member per month, so realized dollars run a little under it.
Money a building misses doesn't go back to the state. It is redistributed to other Texas facilities. Over the first half of Year 9, government-owned buildings forfeited about 11.5% of their stake, most of it on staffing.
See what your building earned and forfeited, from HHSC’s published results.
The three calendars
- The program year runs September 1 to August 31. Year 10 is September 2026 to August 2027.
- The measured quarter is a calendar quarter, and QIPP's Q1 is July to September. Year 10's first quarter is July through September 2026, the quarter ending now.
- Payment comes about eight and a half to nine months after the quarter ends: CMS publishes about four months after, HHSC's scorecard follows about two months later, and the MCO pays within 20 days.
Until HHSC's scorecard for a quarter is out, any dollar figure for it is a projection, and should be labeled as one.
What moves the result
- Every resident counts. A single quarter against a narrow band means one resident can be the difference between met and missed.
- Pressure ulcers, then component 3. Each component 4 metric is half the component, and each component 3 metric is a third. Pressure ulcers is the largest MDS leak statewide, and it recovers quarter to quarter.
- Component 1 needs only two metrics met. Know which buildings are sitting on exactly two.
- The ladder tightens. If you're on the improvement track, plan for the fourth quarter's target, not the first.
- Staffing is the biggest leak, and it's payroll. Component 2 forfeits the most money, but no amount of MDS work moves it.
How SuperQM helps Texas buildings
SuperQM scores every QIPP metric from your own charting for the quarter you're in, against that quarter's target, and names the residents who decide it. Our QIPP engine reproduces all 7,610 of HHSC's Year 9 component payouts from the same inputs.
For every Texas building's published history, try the free Texas QIPP explorer.
