The Texas Incentives for Physicians and Professional Services program is one of four directed payment programs (DPPs) HHSC submitted to the Centers for Medicare and Medicaid Services (CMS) for approval as part of the Delivery System Reform Incentive Payment Transition Plan. CMS approved TIPPS for state fiscal year (SFY) 2022 (Year [Y] 1) on March 25, 2022. CMS approved TIPPS for SFY 2023 (Y2) on August 1, 2022.
Background
TIPPS is a DPP for certain physician groups providing health care services to children and adults enrolled in the STAR, STAR+PLUS and STAR Kids Medicaid managed care programs. Eligible physician groups include health-related institutions (HRIs), indirect medical education (IME) physician groups affiliated with hospitals and other physician groups.
The program includes three components:
- Component 1: Uniform dollar increase paid monthly. Physician groups affiliated with an HRI or a hospital receiving the IME add-on are eligible for Component 1.
- Component 2: Uniform rate enhancement paid semiannually. Physician groups affiliated with an HRI or a hospital receiving the IME add-on are eligible for Component 2.
- Component 3: Uniform rate enhancement for certain outpatient services. All physician groups are eligible for Component 3.
Proposed SFY 2024 (Y3) Measures and Requirements
The proposed quality requirements and measures are submitted to CMS for annual program review and approval. The final quality measures and reporting requirements will be posted following CMS' approval.
- Proposed Y3 Requirements (PDF) (2/23/2023)
- Proposed Y3 Measure Specifications (Excel) (2/23/2023)
- Proposed Y3 Measure Specifications FAQs (Excel) (2/23/2023)
- Stakeholder Feedback for Y3 (PDF) (2/23/2023)
SFY 2023 (Y2) Measures, Requirements, and Evaluation
- Y2 Requirements (PDF) (8/09/2022)
- TIPPS Taxonomy Code Changes for Y2 (PDF) (1/10/2022)
- Y2 Measure Specifications (Excel) (9/23/2022)
- Y2 Measure Specifications FAQs (Excel) (9/23/2022)
- Stakeholder Feedback for Y2 (PDF) (3/1/2022)
SFY 2022 (Y1) Measures, Requirements, and Evaluation
- Y1 Requirements (PDF) (4/8/2022)
- Y1 Measure Specifications (Excel) (8/09/2022)
- Y1 Measure Specifications FAQs (Excel) (8/09/2022)
- Stakeholder Feedback for Y1 (PDF) (3/8/2021)
- Y1 Provider-Reported Data (Excel) (10/27/2022)
Rules
Contact Information
- Visit the HHSC Provider Finance Department website for more enrollment, eligibility and payment information for TIPPS.
- For program eligibility and financial questions, email pfd_tipps@hhs.texas.gov
- For questions on TIPPS quality requirements and reporting, email DPPQuality@hhs.texas.gov.