| (a) Introduction. This section establishes the quality
metrics for the Texas Incentives for Physician and Professional Services
(TIPPS) program.
(b) Definitions. Terms that are used in this and other
sections of this subchapter 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 quality metrics for each TIPPS capitation
rate component as described in §353.1309(g) of this subchapter.
Any quality metric included in TIPPS will be evidence-based and identified
as a structure, process, or outcome measure. HHSC may modify quality
metrics from one program period to the next. The proposed quality
metrics for a program period will be presented to the public for comment
in accordance with subsection (g) of this section.
(d) Performance requirements. For each program period,
HHSC will specify the performance requirements associated with designated
quality metrics. The proposed performance requirements for a program
period will be presented to the public for comment in accordance with
subsection (g) of this section. Achievement of performance requirements
will trigger payments as described in §353.1309 of this subchapter.
(e) Quality metrics and program evaluation. HHSC will
use reported performance of quality metrics to evaluate the degree
to which the arrangement advances at least one of the goals and objectives
that are incentivized by the payments described under §353.1309(g)
of this subchapter.
(1) All quality metrics for any Component in which
a physician group is participating must be reported by the participating
physician group as a condition of participation.
(2) 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.
(f) Participating physician group reporting frequency.
(1) Participating physician groups will be required
to report on quality metrics semi-annually unless otherwise specified
by the metric.
(2) Participating physician groups will also be required
to furnish information and data related to quality metrics and performance
requirements established in accordance with subsection (g) of this
section within 30 calendar days after a request from HHSC for more
information.
(g) Notice and hearing.
(1) HHSC will publish notice of the proposed metrics
and their associated performance requirements no later than August
10 of the calendar year that precedes the first month of the program
period. The notice must be published either by publication on the
HHSC website or in the Texas Register. The
notice required under this section will include:
(A) instructions for interested parties to submit written
comments to HHSC regarding the proposed metrics and performance requirements;
and
(B) the date, time, and location of a public hearing.
(2) Written comments will be accepted within 30 calendar
days of publication. There will also be a public hearing within that
30-day period to allow interested persons to present comments on the
proposed metrics and performance requirements.
(h) Quality metric publication. Final quality metrics
and performance requirements will be provided through the TIPPS quality
webpage on the HHSC website on or before October 1 of the calendar
year that precedes the first month of the program period.
(i) Alternate measures may be substituted for measures
proposed under subsection (g) of this section or published under subsection
(h) of this section if required by the Centers for Medicare and Medicaid
Services for federal approval of the program. If the Centers for Medicare
and Medicaid Services requires changes to quality metrics or performance
requirements after October 1, HHSC will provide notice of the changes
through the HHSC website.
(j) 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.
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| 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; amended to be effective November 13, 2024, 49 TexReg 8853 |
