Texas Incentives for Physicians and Professional Services

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 92215.
    • 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.

Methodology/Rules

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.

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

Pre-Print Packages

View Approved SFY 2022 TIPPS Pre-Print Package as of 4/21/2022 (.zip) (Posted 05/20/2022)

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. A PDF version of the application is available here (.pdf). Enrollment is now closed.

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

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

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 06/16/2022)

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)

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 (.xslx) Updated 09/15/2022)

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

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

Component 2 Scorecards

Component 2 (25percent 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.

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 92215. 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 (.xslx) Updated 09/15/2022)

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 (.xslx)).

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. A PDF version of the application is available here (.pdf).

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

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

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).

TIPPS Scorecards

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 (.xslx) Updated 04/27/2022)

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

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

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

View FINAL TIPPS SFY 22 (Year 1) August Component 1 Scorecard (.xslx) 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 (.xslx) Updated 04/27/2022)

View FINAL TIPPS SFY 22 (Year 1) Mar-Aug Component 2 Scorecard (.xslx) 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 92215. 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 (.xslx) Updated 05/12/2022)