Texas Incentives for Physicians and Professional Services (TIPPS) Program

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 on March 25, 2022.

Background

TIPPS is a DPP for certain physician practice groups providing health care services to children and adults enrolled in the STAR, STAR+PLUS and STAR Kids Medicaid managed care programs. Eligible physician practice groups include health-related institutions (HRIs), indirect medical education (IME) physician practice groups affiliated with hospitals and other physician practice groups.

The program includes three components:

Component 1: Uniform dollar increase paid monthly that includes structure measures on quality improvement activities. Physician practice groups affiliated with a HRI or a hospital receiving the IME add-on are eligible for Component 1.
Component 2: Uniform rate enhancement paid semiannually that includes measures focused on primary care and chronic care. Physician practice groups affiliated with a HRI or hospital receiving the IME add-on are eligible for Component 2.
Component 3: Uniform rate enhancement for certain outpatient services that includes measures focused on maternal health, chronic care, behavioral health, and Social Determinants of Health. All physician practice groups are eligible for Component 3.