Current through Reg. 49, No. 38; September 20, 2024
(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 §
RSA 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.
