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RULE §353.1311Quality Metrics for the Texas Incentives for Physicians and Professional Services Program

(a) Introduction. This section establishes the quality metrics that may be used in the Texas Incentives for Physician and Professional Services (TIPPS) program.

(b) Definitions. Terms that are used in this section may be defined in §353.1301 of this subchapter (relating to General Provisions) or §353.1309 of this subchapter (relating to the Texas Incentives for Physicians and Professional Services).

(c) Quality metrics. For each program period, HHSC will designate one or more metrics for each TIPPS capitation rate component.

  (1) Each quality metric will be identified as a structure measure, improvement over self (IOS) measure, or benchmark measure.

  (2) Any metric developed for inclusion in TIPPS will be evidence-based.

(d) Quality metric requirements. For each program period, HHSC will specify the requirements that will be associated with the designated quality metric.

  (1) A physician group must report all quality metrics in any Component in which it is participating as a condition of participation. Participating physician groups must stratify any reported data by payor type and must report data according to requirements published under subsection (f) of this section.

  (2) Reporting frequency. Quality metrics will be reported semi-annually unless otherwise specified by the quality metric. Participating physician groups will also be required to furnish information and data related to quality measures and performance requirements established in accordance with subsection (e) of this section within 30 calendar days after a request from HHSC for more information.

(e) Notice and hearing.

  (1) HHSC will publish notice of the proposed metrics and their associated requirements no later than January 31 preceding the first month of the program period. The notice must be published either by publication on HHSC's website or in the Texas Register. The notice required under this section will include the following:

    (A) instructions for interested parties to submit written comments to HHSC regarding the proposed metrics and requirements; and

    (B) the date, time, and location of a public hearing.

  (2) Written comments will be accepted for 15 business days following publication. There will also be a public hearing within that 15-day period to allow interested persons to present comments on the proposed metrics and requirements.

(f) Publication of Final Metrics and Requirements. Final quality metrics and requirements will be provided through HHSC's website on or before February 28 of the calendar year that also contains the first month of the program period. If Centers for Medicare and Medicaid Services requires changes to quality metrics or requirements after February 28 of the calendar year, HHSC will provide notice of the changes through HHSC's website.

(g) Evaluation Reports.

  (1) HHSC will evaluate the success of the program based on a statewide review of reported metrics. HHSC may publish more detailed information about specific performance of various participating physician groups, classes of physician groups, or service delivery areas.

  (2) HHSC will publish interim evaluation findings regarding the degree to which the arrangement advanced the established goal and objectives of each capitation rate component.

  (3) HHSC will publish a final evaluation report within 270 days of the conclusion of the program period.

Source Note: The provisions of this §353.1311 adopted to be effective March 21, 2021, 46 TexReg 1617; amended to be effective May 31, 2022, 47 TexReg 3113

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