On June 1, 2021, hospitals will receive access to their state fiscal year (SFY) 2020 Potentially Preventable Readmissions (PPR) and Potentially Preventable Complications (PPC) hospital-level portable document format (PDF) reports and underlying Excel™ data files.
These reports are compiled using fee-for-service claims and managed care organization inpatient data from September 1, 2019, to August 31, 2020 (SFY 2020). For this reporting period, payment adjustments to hospitals based on PPR and PPC performance will be effective from September 1, 2021, to August 31, 2022 (SFY 2022).
In a change from PPR reports of previous reporting periods, payment adjustments for SFY 2022 will be based on a hospital’s unweighted PPR results in relation to statewide norms.
In addition, data determined to be from a hospital stay involving COVID-19 will be excluded from analysis for both PPR and PPC payment adjustments.
The hospital-level PDF reports and underlying Excel data files will be delivered on June 1, 2021, to user accounts on the TMHP secure provider portal. To access this portal, visit tmhp.com:
- Click on Provider, on the top banner, then click on My Account, and enter the proper credentials.
- The PPR and PPC reports are available for download under the Potentially Preventable Events (PPE) Provider Reports
Personnel who routinely access Remittance and Status Reports, submit claims, and check eligibility will be granted access to download the reports from the portal.
For technical assistance with accessing the provider portal or creating an account, users must contact the TMHP EDI Helpdesk at 888-863-3638, from 7 a.m. to 7 p.m., Central Time. More information can be found on the TMHP website under the “Resources” banner.
Providers can find more information about the hospital quality-based PPR and PPC program on the HHS Potentially Preventable Events (PPE) webpage: hhs.texas.gov/about-hhs/process-improvement/Medicaid-chip-quality-efficiency-improvement/potentially-preventable-events. This webpage contains additional documents and resources pertaining to this program.
Providers with questions about this program can email questions to MCD_PPR_PPC@hhsc.state.tx.us.
For more information, call the TMHP Contact Center at 800-925-9126.