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PPR and PPC Performance Reports for Hospitals Accessible June 1, 2024

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Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to Medicaid members who are enrolled in their MCO. Administrative procedures, such as prior authorization, precertification, referrals, and claims and encounter data filing, may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the member’s specific MCO for details.

On June 1, 2024, hospitals will receive access to their 2023 state fiscal year (SFY) Potentially Preventable Readmissions (PPR) and Potentially Preventable Complications (PPC) hospital-level PDF reports and underlying Excel data files.

These reports are compiled using fee-for-service claims and MCO inpatient data from September 1, 2022, to August 31, 2023, (SFY 2023). For this reporting period, payment adjustments to hospitals based on PPR and PPC performance will be effective from September 1, 2024, to August 31, 2025, (SFY 2025).

On June 1, 2024, the reports and data files will be delivered to user accounts on the Texas Medicaid & Healthcare Partnership (TMHP) secure provider portal. To access this portal, visit the TMHP web page and follow these steps:

  1. Click on My Account in the top banner, and enter the proper credentials.
  2. Click on the Potentially Preventable Events (PPE) Provider Reports tab to download the PPR and PPC reports.

Note: Only personnel who routinely access Remittance and Status (R&S) Reports, submit claims, and check eligibility can access and download the reports from the portal.

For technical assistance with accessing the provider portal or creating an account, call the TMHP EDI Help Desk at 888-863-3638 from 7 a.m. to 7 p.m. Central time. Providers can also visit tmhp.com for more information about provider support services.

Information about the hospital quality-based PPR and PPC program is available on the Texas Health and Human Services (HHS) PPE web page. This web page features additional documents and resources that pertain to this program.

Email MCD_PPR_PPC@hhsc.state.tx.us if you have any questions about the program, or call the TMHP Contact Center at 800-925-9126.