The Texas Incentives for Physicians and Professional Services program is one of four directed payment programs HHSC has submitted for CMS approval as part of the Delivery System Reform Incentive Payment Transition Plan. The proposed start date is September 1, 2021.
Background
TIPPS is a value-based directed payment program for certain physician groups providing health care services to children and adults enrolled in the STAR, STAR+PLUS and STAR Kids Medicaid programs. Eligible physician groups include health-related institutions, indirect medical education physician groups affiliated with hospitals and other physician groups.
In Year 1, the program would include the three components:
- Component 1 would be paid as a per-member-per-month payment tied to requirements to implement quality improvement activities. HRIs and IMEs are eligible for Component 1.
- Component 2 would serve as a uniform rate enhancement based on achievement of quality metrics focused on primary care for adults and children and chronic care. HRIs and IMEs are eligible for Component 2.
- Component 3 would serve as a rate enhancement for certain outpatient services based on achievement of quality metrics focused on maternal health, chronic care, behavioral health, and Social Determinants of Health. All physician practice groups are eligible for Component 3.
Program Rules and Requirements
- TIPPS rules §353.1309 and §353.1311
- TIPPS Requirements (PDF) (3/1/2021)
- TIPPS Stakeholder Feedback (PDF) (3/8/2021)
- Measure Specifications for TIPPS (Excel) (8/2/2021)
- Measure Specifications FAQs (Excel) ( 8/2/2021)
Contact Information
- Visit the HHSC Provider Finance website for more enrollment, eligibility and payment information for TIPPS.
- For financial questions, email PFDAcuteCare@hhs.texas.gov.
- If you have questions about TIPPS quality requirements, email DPPQuality@hhs.texas.gov.