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Measuring Managed Care Performance

National Committee for Quality Assurance Health Plan Ratings

Follow the link below to view the most recent ratings of MississippiCAN’s coordinated care organizations (CCOs) published by the National Committee for Quality Assurance.

Child and Adult Core Sets Measure Trend Snapshot

The Child and Adult Core Sets consist of a set of measures that, taken together, assess the delivery of health care services to Medicaid and CHIP beneficiaries. These measures allow the Centers for Medicare and Medicaid Services (CMS) and states to identify areas of stronger performance, improvements over time, and areas of continued focus for improving health outcomes. Starting with the 2024 Core Set, reporting of the Child Core Set and the behavioral health measures on the Adult Core Set became mandatory.

The report for FFY 2024 includes the 2022 through 2024 Child and Adult Core Sets. This Snapshot also shows the state’s performance on these quality measures as it compares to other states for each reporting year and highlights trends in performance over time where available. The tables reflect data reported by the state to CMS as of April 28, 2025.

The FFY 2019 report consists of the Federal Fiscal Year (FFY) 2019 Child and Adult Core Sets Measure Trend Snapshot display’s states’ performance on the frequently reported measures in the Child and Adult Core Sets for FFY 2015 through FFY 2019. The tables also show how Mississippi’s performance compares to performance reported by other states for each reporting year and highlights trends in performance over time. The tables reflect data reported by the Mississippi Division of Medicaid to CMS as of May 31, 2020.

Managed Care Value-Based Withhold Program

In state fiscal year (SFY) 2020, the Mississippi Division of Medicaid (DOM) implemented a Managed Care Value-Based Withhold on MississippiCAN capitation rate payments. This quality withhold is based on established quality metrics, such as Healthcare Effectiveness Data and Information Set (HEDIS) scores, which are already being reported by the CCOs.

DOM set a 1% withhold of capitation rates starting in SFY 2020. DOM updated the withhold of capitation rates to 2% beginning in SFY 2026.

MLR Audit Reports

Medical Loss Ratio (MLR) Audit Reports by state fiscal year for MississippiCAN and the Children’s Health Insurance Program (CHIP).

MississippiCAN

CHIP

Cash Disbursements Encounter Reconciliation Report

The Encounter Data submissions are validated according to the Cash Disbursement Journal of the Contractor and any of its applicable Subcontractors. The measurement report for this validation shall be the Encounter Claims to Cash Disbursements Report for the twenty-four (24) month period ending with the state’s fiscal year end period for the month of June of the current year. This measurement period shall apply to Encounter Claims for the Contractor and all Subcontractors as measured by the Entire Plan and each Service category.

Managed Care Liquidated Damages

The following table shows all managed care liquidated damages assessed by the Mississippi Division of Medicaid since January 2018.