1. (a) Introduction. This section establishes the quality metrics that may be used in the Texas Incentives for Physician and Professional Services (TIPPS) program.

2. (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 §353.1309 of this subchapter (relating to the Texas Incentives for Physicians and Professional Services).

   1. (1) Baseline--An initial standard used as a comparison against performance in each metric throughout the program period to determine progress in the quality metrics.
   2. (2) Benchmark--A metric-specific initial standard set prior to the start of the program period and used as a comparison against a physician group's progress throughout the program period.
   3. (3) Measurement Period (MP)--The time period used to measure achievement of a quality metric.

3. (c) Quality metrics. For each program period, HHSC will designate one or more metrics for each TIPPS capitation rate component.

   1. (1) Each quality metric will be identified as a structure measure, improvement over self (IOS) measure, or benchmark measure.
   2. (2) Any metric developed for inclusion in TIPPS will be evidence-based.

4. (d) Performance requirements. For each program period, HHSC will specify the performance requirement that will be associated with the designated quality metric. Achievement of performance requirements will trigger payments for the TIPPS capitation rate components as described in §353.1309 of this subchapter. The following performance requirements are associated with the quality metrics described in subsection (c) of this section.

   1. (1) A physician group must report all quality metrics in any Component in which it is participating to be eligible for payment.

   2. (2) Achievement of quality metrics.

      1. (A) To achieve a structure measure, providers must report their progress on associated activities for each MP.
      2. (B) Achievement of an IOS measure is based on reporting of the baseline for each MP. For each program period except the one beginning September 1, 2021, achievement is based on meeting or exceeding during the MP the benchmark set prior to the start of the program period.
      3. (C) Achievement of a benchmark measure is based on reporting for each MP and meeting or exceeding during the MP the benchmark set prior to the start of the program period.
   3. (3) Reporting frequency. Achievement will be reported semi-annually unless otherwise specified by the quality metric.

5. (e) Notice and hearing.

   1. (1) HHSC will publish notice of the proposed metrics and their associated performance 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:

      1. (A) instructions for interested parties to submit written comments to HHSC regarding the proposed metrics and performance requirements; and
      2. (B) the date, time, and location of a public hearing.
   2. (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 performance requirements.
6. (f) Publication of Final Metrics and Performance Requirements. Final quality metrics and performance 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 performance requirements after February 28 of the calendar year but before the first month of the program period, HHSC will provide notice of the changes through HHSC's website.

Source Note:The provisions of this §353.1311 adopted to be effective March 21, 2021, 46 TexReg 1617.