Texas Administrative Code › Title 1 - ADMINISTRATION › Part 15 - TEXAS HEALTH AND HUMAN SERVICES COMMISSION › Chapter 353 - MEDICAID MANAGED CARE › Subchapter O - DELIVERY SYSTEM AND PROVIDER PAYMENT INITIATIVES › Section 353.1309 - Texas Incentives for Physicians and Professional Services

Current through Reg. 49, No. 28; July 12, 2024
(a) Introduction. This section establishes
				  the Texas Incentives for Physicians and Professional Services (TIPPS) program.
				  TIPPS is designed to incentivize physicians and certain medical professionals
				  to improve quality, access, and innovation in the provision of medical services
				  to Medicaid recipients through the use of metrics that are expected to advance
				  at least one of the goals and objectives of the state's managed care quality
				  strategy.
(b) Definitions. The
				  following definitions apply when the terms are used in this section. Terms that
				  are used in this section may be defined in §
										353.1301 of this subchapter
				  (relating to General Provisions) or §
										353.1311 of this subchapter
				  (relating to Quality Metrics for the Texas Incentives for Physicians and
				  Professional Services Program).
(1) Health
				  Related Institution (HRI) physician group--A network physician group owned or
				  operated by an institution named in Texas Education Code §
											63.002.
(2) Indirect Medical Education (IME)
				  physician group--A network physician group contracted with, owned, or operated
				  by a hospital receiving either a medical education add-on or a teaching medical
				  education add-on as described in §
											355.8052 of this title (relating to
				  Inpatient Hospital Reimbursement) for which the hospital is assigned or retains
				  billing rights for the physician group.
(3) Intergovernmental Transfer (IGT)
				  Notification--Notice and directions regarding how and when IGTs should be made
				  in support of the program.
(4)
				  Network physician group--A physician group located in the state of Texas that
				  has a contract with a Managed Care Organization (MCO) for the delivery of
				  Medicaid-covered benefits to the MCO's enrollees.
(5) Network status--A provider's network
				  status with a contracted MCO, as determined by the national provider
				  identification (NPI) number and Plan Code combination.
(6) Other physician group--A network
				  physician group other than those specified under paragraphs (1) and (2) of this
				  subsection.
(7) Plan code--A unique
				  2-digit alphanumeric code established by HHSC denoting the individual managed
				  care organization, program, and service delivery area.
(8) Program period--A period of time for
				  which an eligible and enrolled physician group may receive the TIPPS amounts
				  described in this section. Each TIPPS program period is equal to a state fiscal
				  year beginning September 1 and ending August 31 of the following
				  year.
(9) Suggested IGT
				  responsibility--Notice of potential amounts that a governmental entity may wish
				  to consider transferring in support of the program.
(10) Total program value--The maximum amount
				  available under the TIPPS program for a program period, as determined by
				  HHSC.