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 Organizations (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

TIPPS is a physician-directed payment program (DPP) for certain physician groups to help cover the cost of healthcare 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 the Texas Health and Human Services Commission (HHSC) to direct reimbursement increases where they are most needed and to align with the program’s quality goals.

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 severe conditions to improve their quality of life and independence, reduce mortality rates, and better manage the leading drivers of healthcare costs.

TIPPS includes the following components in State Fiscal Year (SFY) 2025:

Component 1 is a uniform rate increase paid at the time of claim adjudication that includes measures focused on primary care and chronic care (90 percent of the total program value). HRIs and IME physician groups are eligible to participate in Component 1.
Component 2 is not part of the TIPPS program in SFY 2025.
Component 3 is a uniform rate enhancement for certain outpatient services including measures focused on maternal health, behavioral health, and non-medical drivers of health (10 percent of the total program value).
- Component 3 rate enhancements will be applied to the following nine Current Procedural Terminology (CPT) codes that align with the measures: 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, and 99215.
- All physician groups enrolled with an 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)
CMS Renewal Approval Letter for SFY 2024 TIPPS (July 31, 2023) (.pdf)
CMS Renewal Approval Letter for SFY 2025 TIPPS (July 31, 2024) (.pdf)

Methodology/Rules

HHSC adopted 1 Texas Administrative Code (1 TAC) Section 353.1309 concerning the TIPPS program and 1 TAC Section 353.1311 concerning Quality Metrics for the TIPPS program. An update to 1 TAC Section 353.1309 was published in the January 26, 2024 issue of the Texas Register (49 TexReg 413) and became effective on January 28, 2024.

The rules establish the TIPPS program and describe the circumstances under which HHSC will direct MCOs to pay physician groups for providing physician and professional services. These payments could include a uniform per member per month payment, certain incentive payments, or a uniform percentage rate increase to physician groups in the MCO's network in a participating service delivery area.

The rules are available here: 1 TAC Section 353.1309 and 1 TAC Section 353.1311. (updated 03/24/2025)

Please see the adoption preamble and rule text for 1 TAC Section 353.1309 (.pdf), relating to TIPPS, effective January 2024.

Pre-Print Packages

TIPPS Participants

List of SFY 2025 TIPPS Participants and SFY 2026 TIPPS Applicants (.xlsx) (updated 03/24/2025)

State Fiscal Year 2026 (Year 5)

Enrollment

HHSC collected enrollment applications for TIPPS from February 3, 2025, through February 24, 2025. Enrollment is now closed.

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 the Excel file can be located here (.xlsx). (Updated 5/9/2025)

The modeling is available here (.pdf) and the excel file can be located here (.xlsx). (Updated 5/9/2025)

IGT Declaration of Intent form is available here (.xlsx). (Updated 5/2/2025)

State Fiscal Year 2025 (Year 4)

Enrollment

HHSC collected enrollment applications for TIPPS from February 1, 2024, through February 21, 2024. Enrollment is now closed.

Suggested IGT

Note: Suggested amounts for the second IGT call have been updated to reflect changes to the model and total IGT collected in the first call.

The modeling is available here (.pdf) and the excel file can be located here (.xlsx). (Updated 8/5/2024)

IGT Declaration of Intent form is available here (.xlsx). (Updated 5/16/2024)

Component 1 Rate Increase by NPI

Component 1 is a uniform rate increase paid at the time of claim adjudication that includes measures focused on primary and chronic care. HRI and IME physician groups are eligible to participate in Component 1. The file linked below reflects the rate increase by National Provider Indicator (NPI) that should be applied to the specified Component 1 procedure and taxonomy codes for HRI and IME physician groups from September 1, 2024, through August 31, 2025.

TIPPS SFY25 (Year 4) Component 1 Rate Increase by NPI (.xlsx) (Updated 8/16/2024)

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 enrolled with an MCO for the delivery of Medicaid-covered benefits are eligible to participate in Component 3. The file linked below reflects the rate increase by NPI that should be applied to the specified Component 3 procedure and taxonomy codes for all physician groups from September 1, 2024, through August 31, 2025.

TIPPS SFY25 (Year 4) Component 3 Rate Increase by NPI (.xlsx) (Updated 8/16/2024)

State Fiscal Year 2024 (Year 3)

Enrollment

HHSC collected enrollment applications from February 1, 2023, through February 21, 2023. Enrollment is now closed.

Component 1 Scorecards

Component 1 (65 percent of the TIPPS funding) is a uniform dollar increase paid prospectively monthly. HRI and IME providers are eligible to participate in Component 1. MCOs must make HHSC-calculated payments to a TIPPS provider in accordance with the scorecard.

TIPPS SFY24 (Year 3) September Component 1 Scorecard (.xlsx) (Updated 9/15/2023)

TIPPS SFY24 (Year 3) October Component 1 Scorecard (.xlsx) (Updated 10/16/2023)

TIPPS SFY24 (Year 3) November Component 1 Scorecard (.xlsx) (Updated 11/15/2023)

TIPPS SFY24 (Year 3) December Component 1 Scorecard (.xlsx) (Updated 12/15/2023)

TIPPS SFY24 (Year 3) January Component 1 Scorecard (.xlsx) (Updated 1/16/2024)

TIPPS SFY24 (Year 3) February Component 1 Scorecard (.xlsx) (Updated 2/15/2024)

TIPPS SFY24 (Year 3) March Component 1 Scorecard (.xlsx) (Updated 3/15/2024)

TIPPS SFY24 (Year 3) April Component 1 Scorecard (.xlsx) (Updated 4/15/2024)

TIPPS SFY24 (Year 3) May Component 1 Scorecard (.xlsx) (Updated 5/15/2024)

TIPPS SFY24 (Year 3) June Component 1 Scorecard (.xlsx) (Updated 6/17/2024)

TIPPS SFY24 (Year 3) July Component 1 Scorecard (.xlsx) (Updated 7/15/2024)

TIPPS SFY24 (Year 3) August Component 1 Scorecard (.xlsx) (Updated 8/15/2024)

Component 2 Scorecards

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

TIPPS SFY24 (Year 3) Sept-Feb Component 2 Scorecard (.xlsx) (Updated 2/15/2024)

TIPPS SFY24 (Year 3) Mar-Aug Component 2 Scorecard (.xlsx) (Updated 8/15/2024)

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.

TIPPS SFY24 (Year 3) Component 3 Rate Increase by NPI (.xlsx) (Updated 9/15/2023)

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 11/3/2023)

The modeling is available here (.pdf), and the excel can be located here (.xlsx) (Updated 3/8/2024)

IGT Declaration of Intent form is available can be located here (.xlsx).(Updated 5/17/2023)

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.

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

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

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 8/16/2022)

The modeling is available here (.pdf), and the excel can be located here (.xlsx) (Updated 6/16/2022)

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.

TIPPS SFY 23 (Year 2) September Component 1 Scorecard (.xlsx) (Updated 9/15/2022)

TIPPS SFY23 (Year 2) October Component 1 Scorecard (.xlsx) (Updated 10/17/2022)

TIPPS SFY23 (Year 2) November Component 1 Scorecard (.xlsx) (Updated 11/15/2022)

TIPPS SFY23 (Year 2) December Component 1 Scorecard (.xlsx) (Updated 12/15/2022)

TIPPS SFY23 (Year 2) January Component 1 Scorecard (.xlsx) (Updated 1/17/2023)

TIPPS SFY23 (Year 2) February Component 1 Scorecard (.xlsx) (Updated 2/15/2023)

TIPPS SFY23 (Year 2) March Component 1 Scorecard (.xlsx) (Updated 3/15/2023)

TIPPS SFY23 (Year 2) April Component 1 Scorecard (.xlsx) (Updated 4/17/2023)

TIPPS SFY23 (Year 2) May Component 1 Scorecard (.xlsx) (Updated 5/15/2023)

TIPPS SFY23 (Year 2) June Component 1 Scorecard (.xlsx) (Updated 6/15/2023)

TIPPS SFY23 (Year 2) July Component 1 Scorecard (.xlsx) (Updated 7/17/2023)

TIPPS SFY23 (Year 2) August Component 1 Scorecard (.xlsx) (Updated 8/15/2023)

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.

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

TIPPS SFY23 (Year 2) Mar-Aug Component 2 Scorecard (.xlsx) (Updated 8/15/2023)

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.

TIPPS SFY 23 (Year 2) Component 3 Rate Increase by NPI (.xlsx) (Updated 9/15/2022)

Reconciliation – SFY2023

As required by 1 TAC Section 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. (updated 03/24/2025)

HHSC has finalized the reconciliation for TIPPS Year 2 (SFY 2023). The calculation methodology is the same one used in SFY 2022 and is based on the actual clients and Medicaid utilization during the program period. HHSC worked closely with participating providers to validate the final SFY 2023 data used for the reconciliation. The summary reconciliation file is available in two formats:

SFY23 TIPPS Year 2 Reconciliation (.xlsx)
SFY23 TIPPS Year 2 Reconciliation (.pdf)

MCOs are directed to issue payment to providers within 20 calendar days from the reconciliation notice. MCOs should work with providers to recover any indicated recoupments. They can use payment plans or other repayment arrangements to recover payments. 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.

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

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

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 5/19/2021)

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.

FINAL TIPPS SFY 22 (Year 1) Sept-Feb Component 1 Scorecard (.xlsx) (Updated 4/27/2022)

FINAL TIPPS SFY 22 (Year 1) March-May Component 1 Scorecard (.xlsx) (Updated 5/12/2022)

FINAL TIPPS SFY 22 (Year 1) June Component 1 Scorecard (.xlsx) (Updated 6/16/2022)

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

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.

FINAL TIPPS SFY 22 (Year 1) Sept-Feb Component 2 Scorecard (.xlsx) (Updated 4/27/2022)

FINAL TIPPS SFY 22 (Year 1) Mar-Aug Component 2 Scorecard (.xlsx) (Updated 8/15/2022)

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.

FINAL TIPPS SFY 22 (Year 1) Component 3 Rate Increase by NPI (.xlsx) (Updated 5/12/2022)

Reconciliation – SFY2022

As required by 1 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. (updated 03/24/2025)

HHSC has finalized the reconciliation for TIPPS Year 1 (SFY 2022). The revised calculation methodology 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 SFY 2022 data used for the reconciliation. The monthly scorecards issued for the program period required rounding based on caseload when calculating amounts. Consequently, a minor adjustment is included in the reconciliation file to account for these remaining funds. The summary reconciliation file is available at the following link: SFY22 TIPPS Year 1 Reconciliation (.xlsx).

Below is a description of each column in the reconciliation file:

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 SFY 2022.
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.

First IGT Reconciliation - SFY 2022 (.xlsx)