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.
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.
Proposed State Fiscal Year (SFY) 2023 (Year [Y]2) Measures, Requirements, and Evaluation
HHSC conducted a public hearing on January 13, 2022 to review proposed measures and reporting requirements for Y2 of TIPPS.
- Proposed Y2 Requirements (PDF) (1/10/2022)
- TIPPS Taxonomy Code Changes for Y2 (PDF) (1/10/2022)
- Proposed Y2 Measure Specification (Excel) (3/1/2022)
- Y2 Measure Specifications FAQs (Excel) (3/1/2022)
- Stakeholder Feedback for Y2 (PDF) (3/1/2022)
- Y2 Evaluation Plan (3/31/2022)
SFY 2022 (Y1) Measures, Requirements, and Evaluation
- Y1 Requirements (PDF) (4/8/2022)
- Y1 Measure Specifications (Excel) (6/1/2022)
- Y1 Measure Specifications FAQs (Excel) (5/16/2022)
- Stakeholder Feedback for Y1 (PDF) (3/8/2021)
- Y1 Evaluation Plan (10/31/2022)
- Preliminary Y1 Evaluation Report (3/31/2022)
- Visit the HHSC Provider Finance Department website for more enrollment, eligibility and payment information for TIPPS.
- For financial questions, email email@example.com
- For questions about TIPPS quality requirements, email DPPQuality@hhs.texas.gov.