Advancing Quality Care for Texas SeniorsTexas Nursing Home Coalition advocates for the resources, policies, and operating environment necessary to improve the lives of nursing home residents and sustain high-quality care across Texas.
Quality care begins with quality support. Texas nursing homes care for some of the state's most medically complex and vulnerable individuals, requiring a skilled workforce, adequate resources, and policies that recognize the realities of long-term care delivery. TNHC advocates for:
By advancing practical, evidence-based solutions, TNHC works to strengthen the quality of care available to Texas seniors today and for generations to come. This year, the Coalition is focused on three key initiatives to deliver quality care improvements: |
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Quality Care Progress in TexasTexas nursing home providers are delivering measurable progress in quality care while navigating extraordinary financial, workforce, regulatory, and operational pressures. From 2019 to 2025, Texas nursing homes improved their CMS Five-Star Quality Measure ranking from 42nd in the nation to 18th, with the state's overall quality measure score rising from 3.02 to 3.75.
That progress reflects the commitment of providers across the state to outcomes-driven care, even as the sector continues to face rising costs, workforce shortages, payment gaps, and increasing regulatory demands. |
A Quality-Focused Policy EnvironmentSince 2020, Texas nursing homes have made significant, measurable progress in improving quality care outcomes for residents. Across key quality measures—including antipsychotic use, falls, weight loss, UTIs, independent mobility, depression, incontinence, antianxiety medication use, pressure ulcers, and catheter use--the data show meaningful improvement in some of the most important areas of patient care. These gains reflect the ongoing commitment of Texas nursing home providers to deliver safer, more effective, and more person-centered care for seniors.
A key driver of this progress is the state's Quality Incentive Payment Program, known as QIPP. QIPP is a proven, 100% earned, pay-for-performance program that directly ties funding to quality outcomes. Nursing homes do not automatically receive these dollars; they must meet required quality standards and continue to improve performance to earn incentive payments. These earned payments are essential to supporting care delivery in Texas nursing homes, accounting for nearly 25% of the reimbursement rate. Each year, QIPP quality metrics become more complex and more difficult to achieve, raising expectations for providers and ensuring that program dollars remain tied to real performance. Importantly, QIPP funds are raised locally and do not use state General Revenue. The results speak clearly: When nursing homes are given a meaningful incentive structure focused on quality, residents benefit. QIPP strengthens accountability, supports continued improvement, and helps ensure Texas seniors receive the high-quality care they deserve. |
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TNHC’s Quality Care Priorities
1. Create a Sustainable Funding Solution |
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The rising costs call for a sustainable funding mechanism. TNHC's proposed reimbursement solution maximizes the funding resources and helps keep pace with inflation. We recommend leveraging the residents' annual Federal Social Security adjustment to support a yearly Medicaid base rate increase without requiring new state appropriations.
2. Develop Patient Care Protection for Medicare Advantage Enrollees |
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The majority of Texas seniors enrolled in both Medicare and Medicaid are choosing Medicare Advantage (MA) plans. Residents enrolled in these MA plans face care delays and denials. Enrollees need basic transparency safeguards to protect their care and ensure the Medicare coverage promise is met.
Access The Coalition Quarterly Archive
Stay up to date with Coalition news and developments through past issues of The Coalition Quarterly, TNHC's member newsletter. You'll find updates on Coalition priorities, advocacy efforts, member resources, and important information impacting Texas nursing home providers.
