Performance Improvement Projects

Performance Improvement Projects (PIPs) are an integral part of Texas Medicaid's managed care quality strategy. The Balanced Budget Act of 1997 requires all states with Medicaid managed care to ensure health plans conduct PIPs. According to 42 CFR 438.330, projects must be designed to achieve, through ongoing measurements and interventions, significant improvement, sustained over time, in clinical care and nonclinical care areas that have a favorable effect on health outcomes and enrollee satisfaction.

HHSC, in consultation with the external quality review organization (EQRO) determines topics for PIPs based on health plan performance.  Health plans create a PIP plan, report on their progress annually, and provide a final report on their PIP. The EQRO evaluates the PIPs in accordance with the Centers for Medicare and Medicaid Services (CMS) EQRO Protocols.

HHSC requires each health plan to conduct two PIPs per program. Each PIP is two years and they implemented on a staggered schedule so that one PIP per program is being implemented each calendar year. One PIP must be a collaborative with another Medicaid/CHIP managed care organization, dental maintenance organization, Delivery System Reform Incentive Payment (DSRIP) project, or community organization.

For more information, email MCD Managed Care Quality