Quality Incentive Payment Program for Nursing Facilities
The Quality Incentive Payment Program (QIPP) is a state directed payment program (DPP) designed to help nursing facilities achieve transformation in care quality through innovation. QIPP was first implemented on Sept. 1, 2017.
This page includes an overview of QIPP and current and proposed requirements and metrics. For rules, regulations and previous years’ requirements and metrics, visit QIPP Overview and History. For reporting and quality improvement resources, visit QIPP Resources.
For information on enrollment, eligibility and payment, visit the QIPP Provider Finance Department.
Background
Two classes of Texas nursing facility (providers) serving residents enrolled in STAR+PLUS Medicaid are eligible to participate:
- Non-state governmental owned entities (NSGO).
- Privately-owned facilities that have a percentage of Medicaid NF days of service that is greater than or equal to 65%.
SFY 2026 (Y9) Metrics and Requirements
CMS approved QIPP for Year 9 on Aug. 15, 2024.
- SFY 2026 (YR9) Quality Metrics (PDF) (10/3/2025)
- Webinar recording: QIPP SFY 2026 Overview (9/10/2025)
- Webinar slide deck: QIPP SFY 2026 Overview (PDF) (9/10/2025)
QIPP SFY 2026 does not require facilities to submit data to HHSC for program quality measures. All quarterly performance data will come directly from CMS public use files (PUFs) available at the Provider Data Catalog.
SFY 2027 (Y10) Metrics and Requirements
HHSC will conduct an online public hearing on Dec. 3, 2025, at 10 a.m. CST to review and receive public comment on quality metrics and performance requirements for SFY 2027 of QIPP. Additional information on this hearing is available on the HHS Meetings and Events page. This hearing was conducted online
SFY 2027 (Y10) Quality Metrics (PDF) (11/6/2025)
Written Public Comments
Written public comments regarding the proposed quality metrics and performance requirements may be submitted until 11:59 p.m. on Dec. 12, 2025, to the QIPP mailbox.
Rules
QIPP is governed by the following Texas Administrative Code (TAC) rules: 353.1301, 353.1302, 353.1303 and 353.1304.
Federal regulatory authority governing QIPP as a state-directed payment program is contained in 42 CFR §438.6(c).
Public Hearing. The meeting provided an Overview of the program and proposed metrics as well as an opportunity for public comment and questions.
SFY 2027 (Y10) Quality Metrics (PDF) (11/6/2025)
Alexa Schuman, Deputy State Long Term Care Ombudsman, stated that the targets and reimbursements for Years 8 and 9 of QIPP have not achieved improved nursing staffing ratios. Texas continues to rank near the bottom in nursing facility staffing, leading to serious resident issues (neglect, injuries, life-threatening risks).
She reiterated that the only reliable data for QIPP is PBJ and that she would detail stories and analysis in her written comments. Her two main points were: facilities must be incentivized to meet staffing goals and targets should be increased to improve resident safety and quality of life. Only 12% of participating facilities met the most recent staffing targets; only about half meet each target quarterly. Current financial incentives pay high sums for very little additional staff time per resident.
She also proposed scaling payments as facilities approach or exceed the CMS recommended minimum, rather than small increments from dangerously low baselines.
Randall Martin, Inside Services and part of the Texas Health Care Association Data Reimbursement Committee, commented on QIPP Component 2 (PBJ metrics).
He requested HHSC maintain the previous years’ earning percentages (60/85/100%) rather than equal weighting of metrics, as current incentives do not cover the real cost of increasing staffing. He raised concerns about QIPP eligibility requirements, especially for private facilities that might have to convert to hospital ownership because they don’t meet the 65% Medicaid requirement or are not near a partner hospital. He stated that current rules prevent these centers from continuing in QIP and asked HHSC to review this situation.
Q and A There were no questions asked.
There being no further comments and no questions, the meeting was adjourned.
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