|(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
(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
(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;
(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.