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Texas Incentives for Physicians and Professional Services

Texas Incentives for Physicians and Professional Services (TIPPS) is a program for certain physician groups that have contracts with one or more Managed Care Organization (MCOs) for the delivery of Medicaid-covered benefits to an MCO's enrollees.  It is not a direct assistance program for Medicaid patients, but TIPPS does provide funding to certain physician groups to encourage provider participation in Medicaid.

Overview

Texas Incentives for Physicians and Professional Services (TIPPS) is a physician-directed payment program (DPP) 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 also serves as a transition from the Network Access Improvement Program (NAIP) and Delivery System Reform Incentive Payment (DSRIP) program for specific physician groups. TIPPS is designed to promote:

  • Optimal health for Texans at every stage of life through prevention and by engaging individuals, families, communities, and the healthcare system to address the root causes of poor health; and
  • Effective practices for people with chronic, complex, and serious conditions to improve their quality of life and independence, reduce mortality rates, and better manage the leading drivers of healthcare costs.

TIPPS is comprised of three components:

  • Component 1 is a uniform dollar increase paid monthly that includes structure measures on quality improvement activities (65 percent of the total program value). HRIs and IMEs are eligible to participate in Component 1.
  • Component 2 is a uniform rate enhancement paid semiannually that includes measures focused on primary care and chronic care (25 percent of the total program value). HRIs and IMEs are eligible to participate in Component 2.
  • Component 3 is a uniform rate enhancement for certain outpatient services that includes measures focused on maternal health, chronic care, behavioral health, and social determinants of health (10 percent of the total program value).
    • Component 3 rate enhancements will be applied to the following nine CPT codes that align with the measures: 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, and 99215.
    • All physician groups otherwise eligible to participate in TIPPS (and enrolled with a Managed Care Organization  (MCO) for the delivery of Medicaid-covered benefits) are eligible to participate in Component 3.

Texas Response to CMS Round 1 Questions for SFY 2023 TIPPS (April 21, 2022) (.pdf)
Texas Response to CMS Round 2 Questions for SFY 2023 TIPPS (May 16, 2022) (.pdf)
Texas Response to CMS Round 3 Questions for SFY 2023 TIPPS (June 8, 2022) (.pdf)
Texas Response to CMS Round 4 Questions for SFY 2023 TIPPS (July 8, 2022) (.pdf) 
CMS TIPPS Approval Letter (March 25, 2022) (.pdf)
CMS Renewal Approval Letter for SFY 2023 TIPPS (August 1, 2022) (.pdf) 

Methodology/Rules

HHSC adopted TAC Rule §353.1309, concerning the TIPPS program, and TAC Rule §353.1311, concerning Quality Metrics for the TIPPS program. An update to Rule §353.1309 was published in the January 26, 2024 issue of the Texas Register and became effective on January 28, 2024.

The 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.

The rules are available here: §353.1309 and §353.1311.

New TAC update effective January 2024: see preamble and rule text here (.pdf)

Pre-Print Packages

View Updated SFY 2022 TIPPS Pre-Print Package as of 09/29/2021 (.zip)
View Updated SFY 2022 TIPPS Pre-Print Package as of 09/15/2021 (.zip)
Reconciliation Visual Applicable to all pre-prints SFY 2022 as of 09/15/2021 (.pdf)
View Approved SFY 2023 TIPPS Pre-Print Package as of 08/01/2022 (.zip)
View Proposed SFY 2022 TIPPS Pre-Print Package of 07/13/2022 (.zip)
View Approved SFY 2022 TIPPS Pre-Print Package as of 04/21/2022 (.zip) (Posted 05/20/2022)
View Proposed SFY 2023 TIPPS Pre-Print Package as of 03/01/2022 (.zip)
View Proposed SFY 2024 TIPPS Pre-Print Package as of 06/01/2023 (.zip)
Approved Pre-Print for SFY 2024 TIPPS
View Proposed SFY 2025 TIPPS Pre-Print Package as of 03/07/2024 (.zip)
View Updated SFY 2025 TIPPS Pre-Print Package as of 05/30/2024 (.zip)
View Updated TIPPS SFY2025 TIPPS Pre-Print Package as of 07/11/2024 (.zip)

State Fiscal Year 2025 (Year 4)

Enrollment

The Texas Health and Human Services Commission (HHSC) collected enrollment applications for TIPPS from February 1, 2024, through February 21, 2024. Enrollment is now closed.
Along with your application, please complete and submit this attachment to PFD_TIPPS@hhs.texas.gov. This is to indicate your network status for SFY 2025 for all billing NPIs you wish to include in your application.

Suggested IGT

Suggested Intergovernmental Transfer (IGT) amounts per SDA and provider for the first and second six months of IGT is available here (.pdf), and excel file can be located here (.xlsx). (Updated 05/31/2024)

The modeling is available here (.pdf) and the excel file can be located here (.xlsx). (Updated 5/15/2024)

NOTE: The SFY25 TIPPS Model has been updated to include Travis and Nueces SDAs.

IGT Declaration of Intent form is available here (.xlsx). (Updated 05/16/2024)

State Fiscal Year 2024 (Year 3)

Enrollment

The Texas Health and Human Services Commission (HHSC) collected enrollment applications from February 1, 2023, through February 21st, 2023. Enrollment is now closed.

Component 1 Scorecards

Component 1 (65 percent of the TIPPS funding) is a uniform dollar increase paid prospectively monthly. Health Related Institutions (HRIs) and Indirect Medical Education (IME) providers are eligible to participate in Component 1. Managed Care Organizations (MCOs) must make HHSC-calculated payments to a TIPPS provider in accordance with the scorecard.

View the TIPPS SFY 24 (Year 3) September Component 1 Scorecard (.xlsx) (Updated 09/15/2023)

View the TIPPS SFY 24 (Year 3) October Component 1 Scorecard  (.xlsx) (Updated 10/16/2023)

View the TIPPS SFY 24 (Year 3) November Component 1 Scorecard (.xlsx) (Updated 11/15/2023)

View the TIPPS SFY 24 (Year 3) December Component 1 Scorecard (.xlsx) (Updated 12/15/2023)

View the TIPPS SFY 24 (Year 3) January Component 1 Scorecard (.xlsx) (Updated 01/16/2024)

View the TIPPS SFY 24 (Year 3) February Component 1 Scorecard (.xlsx) (Updated 02/15/2024)

View the TIPPS SFY 24 (Year 3) March Component 1 Scorecard (.xlsx) (Updated 03/15/2024)

View the TIPPS SFY 24 (Year 3) April Component 1 Scorecard (.xlsx) (Updated 04/15/2024)

View the TIPPS SFY 24 (Year 3) May Component 1 Scorecard (.xlsx) (Updated 05/15/2024)

View the TIPPS SFY 24 (Year 3) June Component 1 Scorecard (.xlsx) (Updated 06/17/2024)

View the TIPPS SFY 24 (Year 3) July Component 1 Scorecard (.xlsx) (Updated 07/15/2024)

We were recently alerted to a potential concern from a provider involving payments not aligning with the anticipated scorecard payments.

Upon careful examination, it became apparent that there was a misalignment associated with the scorecard calculations and an adjustment was necessary to ultimately bring the scorecard payment process closer to the projected total payments. It is important to note that there will be an adjustment for this November scorecard (column W) that reflects changes to the previous scorecards. The payments in the scorecard (column R and column T) should reflect the normalized payments going forward.

We sincerely appreciate the understanding and cooperation of all our stakeholders as we work towards resolving this issue and improving our processes.

Component 2 Scorecards

Component 2 (25 percent of the TIPPS funding) is a uniform rate enhancement paid semiannually that includes measures focused on primary care and chronic care. Health Related Institutions (HRIs) and Indirect Medical Education (IME) providers are eligible to participate in Component 2. Managed Care Organizations (MCOs) must make HHSC-calculated payments to a TIPPS provider in accordance with the scorecard.

View the TIPPS SFY23 (Year 2) Sept-Feb Component 2 Scorecard (.xlsx) (Updated 02/15/2024)

Component 3 Rate Increase by NPI

Component 3 rate enhancements will be applied to the following nine CPT codes that align with the measures: 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, and 99215. All physician groups otherwise eligible to participate in TIPPS and enrolled with an MCO for the delivery of Medicaid covered benefits are eligible to participate in Component 3.

View TIPPS SFY 24 (Year 3) Component 3 Rate Increase by NPI (.xlsx) (Updated 09/15/2023)

Suggested IGT

Suggested Intergovernmental Transfer (IGT) amounts per SDA and provider for the first and second six months of IGT is available here (.pdf), and excel file can be located here  (.xlsx). (Updated 11/03/2023)

The modeling is available here (.pdf), and the excel can be located here  (.xlsx) (Updated 03/08/2024)

IGT Declaration of Intent form is available can be located here  (.xlsx).(Updated 05/17/2023)

State Fiscal Year 2023 (Year 2)

Enrollment

The Texas Health and Human Services Commission (HHSC) collected enrollment applications for TIPPS from March 2, 2022 through March 29, 2022.  Enrollment is now closed.

View Year 2 (SFY 2023) Taxonomy codes (.pdf)

View Year 2 (SFY 2023) Taxonomy codes (.xlsx)

View list of TIPPS Year 2 Provider IDs (.pdf)

Suggested IGT

The 1st 6 Months Suggested Intergovernmental Transfer (IGT) amounts per provider is available here (.pdf), an excel file can be located here (.xlsx). (Updated 08/16/2022)

The modeling is available here (.pdf), and the excel can be located here (.xlsx) (Updated 06/16/2022)

IGT Declaration of Intent form is available here (.pdf), and excel file can be located here (.xlsx).

The 2nd 6 Months Suggested Intergovernmental Transfer (IGT) amounts per provider is available  here (.pdf), and the excel file can be located here (.xlsx).  (Updated 11/3/2022)

Year 2 Additional Suggested Intergovernmental Transfer (IGT) amounts per provider is available here (.pdf), and the excel file can be located here (.xlsx).  (Updated 7/19/2023)

Component 1 Scorecards

Component 1 (65 percent of the TIPPS funding) is a uniform dollar increase paid prospectively on a monthly basis. Health Related Institutions (HRIs) and Indirect Medical Education (IME) providers are eligible to participate in Component 1. Managed Care Organizations (MCOs) must make HHSC-calculated payments to a TIPPS provider in accordance with the scorecard.

View TIPPS SFY 23 (Year 2) September Component 1 Scorecard (.xlsx) (Updated 09/15/2022)

View TIPPS SFY 23 (Year 2) October Component 1 Scorecard (.xlsx) (Updated 10/17/2022)

View TIPPS SFY 23 (Year 2) November Component 1 Scorecard (.xlsx) (Updated 11/15/2022)

View TIPPS SFY 23 (Year 2) December Component 1 Scorecard (.xlsx) (Updated 12/15/2022)

View TIPPS SFY 23 (Year 2) January Component 1 Scorecard (.xlsx) (Updated 01/17/2023)

View TIPPS SFY 23 (Year 2) February Component 1 Scorecard (.xlsx) (Updated 02/15/2023)

View the TIPPS SFY 23 (Year 2) March Component 1 Scorecard (.xlsx) (Updated 03/15/2023)

View the TIPPS SFY 23 (Year 2) April Component 1 Scorecard (.xlsx) (Updated 04/17/2023)

View the TIPPS SFY 23 (Year 2) May Component 1 Scorecard (.xlsx) (Updated 05/15/2023)

View the TIPPS SFY 23 (Year 2) June Component 1 Scorecard (.xlsx) (Updated 06/15/2023)

View the TIPPS SFY 23 (Year 2) July Component 1 Scorecard  (.xlsx) (Updated 07/17/2023)

View the TIPPS SFY 23 (Year 2) August Component 1 Scorecard (.xlsx) (Updated 08/15/2023)

Component 2 Scorecards

Component 2 (25 percent of the TIPPS funding) is a uniform rate enhancement paid semiannually that includes measures focused on primary care and chronic care. Health Related Institutions (HRIs) and Indirect Medical Education (IME) providers are eligible to participate in Component 2. Managed Care Organizations (MCOs) must make HHSC-calculated payments to a TIPPS provider in accordance with the scorecard.

View the TIPPS SFY23 (Year 2) Sept-Feb Component 2 Scorecard (.xlsx) (Updated 02/15/2023)

View the TIPPS SFY23 (Year 2) Mar-Aug Component 2 Scorecard (.xlsx) (Updated 08/15/2023)

Component 3 Rate Increase by NPI

Component 3 rate enhancements will be applied to the following nine CPT codes that align with the measures: 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, and 99215. All physician groups otherwise eligible to participate in TIPPS and enrolled with an MCO for the delivery of Medicaid covered benefits are eligible to participate in Component 3.

View TIPPS SFY 23 (Year 2) Component 3 Rate Increase by NPI (.xlsx) (Updated 09/15/2022)

Reconciliation – SFY2023

As required by TAC 353.1309, HHSC has completed the annual reconciliation for Component 1 to actual Medicaid clients served during the program period and Component 2 to actual Medicaid utilization during the program period. 

HHSC has finalized the reconciliation for TIPPS Year 2 (SFY 2023). The methodology for the calculations is the same one used in SFY2022 and is based on the actual clients served and actual Medicaid utilization during the program period. HHSC worked closely with participating providers to validate the final SFY2023 data used for the reconciliation. The summary reconciliation file is available here (.xlsx) and here (.pdf).

MCOs are directed to issue payments to providers within 20 calendar days from this notice. MCOs should work with providers to recover any recoupments that are indicated but have flexibility to do so using payment plans or other repayment arrangements as needed. All recoupment arrangements and timelines are negotiated between the MCOs and the providers.

First IGT Reconciliation - SFY 2023 (.xlsx)

State Fiscal Year 2022 (Year 1)

Modeling

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 (.xlsx)).

Enrollment

The Texas Health and Human Services Commission (HHSC) collected enrollment applications for the TIPPS program from March 15, 2021, through April 5, 2021 for eligibility period September 1, 2021 to August 31, 2022. The enrollment period is now closed. 

View Year 1 (SFY 2022) Taxonomy codes (.pdf)

View Year 1 (SFY 2022) Taxonomy codes (.xlsx)

View list of TIPPS Year 1 Provider IDs (.pdf)

Suggested IGT

Suggested  (IGT) amounts per provider are available here (.pdf), and the excel file can be located here (.xlsx). (Updated 05/19/2021)

IGT Commitment form is available here (.pdf), and the excel file can be located here (.xlsx).

Component 1 Scorecards

Component 1 (65% of the TIPPS funding) is a uniform dollar increase paid prospectively on a monthly basis. Health Related Institutions (HRIs) and Indirect Medical Education (IME) providers are eligible to participate in Component 1. Managed Care Organizations (MCOs) must make HHSC-calculated payments to a TIPPS provider in accordance with the scorecard.

View FINAL TIPPS SFY 22 (Year 1) Sept-Feb Component 1 Scorecard (.xlsx) (Updated 04/27/2022)

View FINAL TIPPS SFY 22 (Year 1) March-May Component 1 Scorecard (.xlsx) (Updated 05/12/2022)

View FINAL TIPPS SFY 22 (Year 1) June Component 1 Scorecard (.xlsx) (Updated 06/16/2022)

View FINAL TIPPS SFY 22 (Year 1) July Component 1 Scorecard (.xlsx) (Updated 7/15/2022)

View FINAL TIPPS SFY 22 (Year 1) August Component 1 Scorecard (.xlsx) (Updated 8/15/2022)

Component 2 Scorecards

Component 2 (25% of the TIPPS funding) is a uniform rate enhancement paid semiannually that includes measures focused on primary care and chronic care. Managed Care Organizations (MCOs) must make HHSC-calculated payments to a TIPPS provider in accordance with the scorecard.

View FINAL TIPPS SFY 22 (Year 1) Sept-Feb Component 2 Scorecard (.xlsx) (Updated 04/27/2022)

View FINAL TIPPS SFY 22 (Year 1) Mar-Aug Component 2 Scorecard (.xlsx) (Updated 08/15/2022)

Component 3 Rate Increase Percentages

Component 3 rate enhancements will be applied to the following 9 CPT codes that align with the measures: 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, and 99215. All physician groups otherwise eligible to participate in TIPPS and enrolled with an MCO for the delivery of Medicaid covered benefits are eligible to participate in Component 3.

View FINAL TIPPS SFY 22 (Year 1) Component 3 Rate Increase by NPI (.xlsx) (Updated 05/12/2022)

Reconciliation – SFY2022

As required by TAC 353.1309, HHSC has completed the annual reconciliation for Component 1 to actual Medicaid clients served during the program period and Component 2 to actual Medicaid utilization during the program period.  

HHSC has finalized the reconciliation for TIPPS Year 1 (SFY 2022). The revised methodology for the calculations is based on the actual clients served and actual Medicaid utilization during the program period. HHSC worked closely with participating providers to validate the final SFY2022 data used for the reconciliation. The monthly scorecards issued for the program period required rounding based on caseload when calculating amounts; consequently, a small adjustment is included in the reconciliation file to account for these remaining funds. The summary reconciliation file is available here  (.xlsx).

  • Column B shows what the MCOs should pay each NPI based on the updated reconciliation.
  • Column C shows what HHSC had directed MCOs to pay each NPI based on posted scorecards through SFY22.
  • Column D shows the amount of money HHSC is directing each MCO to either recoup from or pay each NPI to account for the difference between B and C.

MCOs are directed to issue payments to providers within 20 calendar days from this notice. MCOs should work with providers to recover any recoupments that are indicated, but have flexibility to do so using payment plans or other repayment arrangements as needed. All recoupment arrangements and timelines are negotiated between the MCOs and the providers.

First IGT Reconciliation - SFY 2022 (.xlsx)