Texas Incentives for Physicians and Professional Services
The Texas Health and Human Services Commission (HHSC) created the Texas Incentives for Physicians and Professional Services (TIPPS) program to synchronize its efforts into one program while transitioning from the Delivery System Reform Incentive Payment (DSRIP) program and the Network Access Improvement Program (NAIP). TIPPS is a directed payment program for certain physician groups to help cover the cost of health care services provided to persons with Medicaid enrolled in STAR STAR+PLUS, and STAR Kids.
Eligible physician groups include: Health-Related Institution (HRI) physician groups, Indirect Medical Education (IME) physician groups, and other physician groups. These classifications allow HHSC to direct reimbursement increases where they are most needed and to align with the quality goals of the program. TIPPS payments are paid to the Medicaid Managed Care Organizations (MCOs) through three components as a part of their capitation rates and distributed to eligible physician groups based on each physician group’s achievement of performance requirements collected twice per year. Component 1 is a monthly performance incentive payment based upon the implementation of quality improvement activities. Component 2 is a semi-annual performance incentive payment based on achievement of quality metrics focused on primary care and chronic care. Only health-related institutions and indirect medical education practice groups are eligible for Components 1 and 2. Component 3 is a uniform rate increase on paid claims for certain outpatient services based on the achievement of quality metrics that measure aspects of maternal health, chronic care, behavioral health, and social determinants of health. All physician groups are eligible for Component 3.
Enrollment for the TIPPS program began on March 15, 2021 and closed on April 5, 2021 for eligibility period September 1, 2021 to August 31, 2022. A PDF version of the application is available here (.pdf).
HHSC has adopted new §353.1309, concerning the TIPPS program, and new §353.1311, concerning Quality Metrics for the TIPPS program. The new rules were published in the March 12, 2021 issue of the Texas Register and became effective on March 21, 2021.
The new rules establish the TIPPS program and describe the circumstances under which HHSC will direct MCO’s to provide a uniform per member per month payment, certain incentive payments, and a uniform percentage rate increase to physician groups in the MCO's network in a participating service delivery area for the provision of physician and professional services.
HHSC is providing the TIPPS modeling for example purposes only; these are not the final program values. The program values are subject to changes based on actual enrollment, data changes and approval issued by the Centers for Medicare and Medicaid Services (CMS). The TIPPS modeling is updated to reflect the final rules and is available here (.pdf) (excel version of the file here (.xslx)).
Suggested Intergovernmental Transfer (IGT) amounts per provider is available here (.pdf), and excel file can be located here (.xlsx). (Updated 05/06/2021)
IGT Commitment form is available here (.pdf), and excel file can be located here (.xlsx).