Federal Reports

Texas Quality Incentive Payment ProgramQIPP operates as part of the Texas Healthcare Transformation and Quality Improvement Program Waiver (the waiver), which provides health care services delivered through MCOs. QIPP is designed to improve quality and innovation in the provision of nursing facility services, and provides incentive payments to nursing facilities that meet performance requirements on specified quality measures. According to the State agency’s request to CMS for QIPP approval, payments from MCOs to qualified nursing facilities would “be based on improvements on specific quality measures.” The State agency also stated that nursing facilities “must make incremental improvements toward preset goals to qualify for payments.” Unlike the payments that were made under the UPL Program and MPAP, QIPP payments are available to private nursing facilities as well as NSGO facilities. Once appropriately claimed by the State, Federal regulations do not dictate how QIPP payments must be used by NSGE, NSGO facilities, or privately owned facilities.QIPP payments are comprised of three components. Component One payments are available only to NSGO facilities and are calculated to equal 110 percent of the IGTs that NSGEs provide to the State agency as the State share of QIPP funding. Texas defines an IGT as a “transfer of public funds” such as “taxes, assessments, levies, investments,” or “other public revenues.” Component One payments are made to NSGEs each month that NSGO facilities submit a Quality Assurance Performance Improvement (QAPI) Validation Report to the State agency. These payments are retained in full by the NSGEs. Component Two and Component Three payments are available to all QIPP-participating nursing facilities that meet individual performance requirements (described below), and are based on the amount of QIPP funding available after Component One payments are made. In addition to Component One, Component Two, and Component Three payments, all QIPP nursing facilities are eligible for “lapse funds.” Lapse funds are funds that are not distributed because one or more nursing facilities failed to meet QAPI reporting requirements or quality metrics. Lapse funds are redistributed to all nursing facilities based on each nursing facility’s proportion of the combined total QIPP-earned Component One, Component Two, and Component Three funds. MCOs retain a small percentage of the payments and lapse funds, and pay the balance to NSGEs and private nursing facilities.In its first year, 428 NSGO facilities and 85 private nursing facilities participated in QIPP, and budgeted expenditures for QIPP totaled $400 million. In the second year, 460 NSGO facilities and 95 private nursing facilities were eligible to participate in QIPP, and the budgeted expenditures totaled $446 million. On February 5, 2019, the State agency announced that it would allocate $600 million to QIPP for year 3 (State FY 2020). In the third year, 459 NSGO facilities and 339 private nursing facilities were eligible to participate in QIPP.

For our audit of the Economic Development Administration’s (EDA’s) disaster relief grants award administrative processes and oversight efforts, our objective was to determine whether EDA’s process for awarding disaster relief grants to applicants is adequate. Specifically, we focused on whether (1) EDA awarded grants on a competitive and merit basis and (2) the extent of EDA’s compliance with the requirements outlined in the Bipartisan Budget Act of 2018 as well as its own policies and procedures for determining which applicants should receive disaster relief funds.We found that EDA is awarding grants on a competitive and merit basis. However, EDA does not always comply with its own policies and procedures for determining which applicants should receive disaster relief funds. Specifically, we found that EDA did not I. ensure all applications documented a clear nexus and resilience principles; II. always use priority order of funding recommendations; and III. always meet its own internal review goals.

The VA Office of Inspector General (OIG) reviewed the measures taken by the Veterans Health Administration’s (VHA) Homeless Program Office, medical facilities, and community service providers to mitigate COVID-19 risks in transitional housing programs for veterans experiencing homelessness.The OIG found that while transitional housing service providers successfully implemented four of six specific Centers for Disease Control and Prevention (CDC) COVID-19 risk mitigation measures, the providers could have strengthened implementation of two others.VHA and service provider staff said the Homeless Program Office allowed them the flexibility to isolate vulnerable veterans, facilitate telehealth exams, and coordinate the provision of medical care in the community. Some service providers and VA medical facilities also developed their own best practices for reducing COVID-19 risks. As the pandemic continues, VHA and its service providers will need to sustain their efforts and strengthen measures to minimize COVID-19 exposure among veterans experiencing or at risk for homelessness.Staff at all 14 facilities assessed by the OIG review team made substantial progress on four measures: cleaning frequently with disinfectant, screening veterans for symptoms, creating isolation site plans, and maintaining adequate cleansing and sanitation supplies and personal protective equipment. The OIG found improved communications from the Homeless Program Office to medical facilities helped these efforts. However, several facilities appeared to struggle with the remaining two measures: identifying high-risk veterans and communicating suggested precautions and social distancing.Interviewees expressed concerns about service providers’ ability to maintain enough personal protective equipment for veterans during the prolonged pandemic. Medical facility staff will need to coordinate with service providers to help them develop contingency plans. The OIG made four recommendations to the under secretary for health regarding additional measures VHA could take to strengthen the implementation of CDC guidelines at the service providers’ facilities.