| (D) Providers must report quality data as described
in §353.1311 of this subchapter as a condition of participation
in the program.
(h) Distribution of TIPPS payments.
(1) Before the beginning of the program period, HHSC
will calculate the portion of each PMPM associated with each TIPPS
enrolled practice group broken down by TIPPS capitation rate component
and payment period. For example, for a physician group, HHSC will
calculate the portion of each PMPM associated with that group that
would be paid from the MCO to the physician group as follows.
(A) Monthly payments from Component One will be equal
to the total value of Component One for the physician group divided
(B) Semi-annual payments from Component Two will be
equal to the total value of Component Two for the physician group
divided by 2.
(C) Payments from Component Three will be equal to
the total value of Component Three attributed as a uniform rate increase
based upon historical utilization.
(2) MCOs will distribute payments to enrolled physician
groups as directed by HHSC. Payments will be equal to the portion
of the TIPPS PMPM associated with the achievement for the time period
in question multiplied by the number of member months for which the
MCO received the TIPPS PMPM.
(i) Changes in operation. If an enrolled physician
group closes voluntarily or ceases to provide Medicaid services, the
physician group must notify the HHSC Provider Finance Department by
hand delivery, United States (U.S.) mail, or special mail delivery
within 10 business days of closing or ceasing to provide Medicaid
services. Notification is considered to have occurred when the HHSC
Provider Finance Department receives the notice.
(j) Reconciliation. HHSC will reconcile the amount
of the non-federal funds actually expended under this section during
each program period with the amount of funds transferred to HHSC by
the sponsoring governmental entities for that same period using the
methodology described in §353.1301(g) of this subchapter.
(k) Recoupment. Payments under this section may be
subject to recoupment as described in §353.1301(j) and §353.1301(k)
of this subchapter.