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Value-Based Incentives

 

Comprehensive Quality Strategy

In accordance with 42 C.F.R. § 438.340, the Mississippi Division of Medicaid (DOM) has developed a Comprehensive Quality Strategy for 2021 – 2024. The Comprehensive Quality Strategy reflects many ongoing and planned quality improvement efforts within the managed care and fee-for-delivery systems.

The Mississippi Division of Medicaid (DOM or Division) requested authority from the Centers for Medicare & Medicaid Services (CMS) for quality initiatives beginning in July 2019. These initiatives cover major sources of Medicaid spending: hospitals (including the state’s academic medical center), physicians, emergency ambulance providers, and coordinated care organizations (CCOs). The programs, as described below, include quality measures, targeted improvement levels and accountability. These programs pertain to the managed care program, Mississippi Coordinated Access Network (MississippiCAN) for the Medicaid Managed Care beneficiaries.

 

External Quality Review (EQR) Protocol 5

The Centers for Medicare & Medicaid Services (CMS) established requirements for states to improve the reliability of encounter data collected from managed care CCOs. In 2016, the Medicaid managed care final rule required states to conduct an independent audit of encounter data reported by each managed care CCO. Revisions to the Medicaid managed care regulations enhanced quality oversight criteria. Under the 2020 final rule, encounter data must include both the allowed and paid amounts and states must annually post on its website CCOs that are exempt from external quality review.

CMS indicated that states could meet the independent audit requirement by conducting an encounter data assessment based on EQR Protocol 55. Protocol 5 evaluates the completeness and accuracy of the encounter data submitted to the State’s fiscal agent contractor (FAC) by the CCOs contracted to provide healthcare services to CAN and CHIP beneficiaries. Although Protocol 5 is a voluntary protocol, CMS strongly encourages states to contract with qualified entities to implement Protocol 5 to meet the audit requirement of the final rule.

Additionally, states are required to provide accurate encounter data to actuaries, as well as CMS, as part of the Transformed Medicaid Statistical Information System (T-MSIS) project. Protocol 5, performed under GAGAS, enables states to meet these data validation and monitoring requirements. Protocol 5 evaluates state/department policies, as well as the policies, procedures, and systems of the CCO, assists states in gauging utilization, identifying potential gaps in services, evaluating program effectiveness, and identifying strengths and opportunities to enhance oversight.

2024 Reports
Magnolia MS EQR P5 Final Report 2024
Molina MS EQR P5 Final Report 2024
UHC MS EQR P5 Final Report 2024

Mississippi Hospital Access Program (MHAP)

The Mississippi Hospital Access Program (MHAP) is a state directed payment arrangement through managed care that is paid monthly to hospitals through the CCOs and is made up of two components: Fee Schedule Adjustment (FSA) and Quality Incentive Payment Program (QIPP). This program is approved by CMS through a preprint that is submitted annually.

 

MHAP by SFY
SFY MHAP-TPP MHAP-FSA MHAP-QIPP Total MHAP
2016 $533,110,956 $ $ $533,110,956
2017 $533,110,956 $ $ $533,110,956
2018 $422,241,632 $110,869,324 $ $533,110,956
2019 $380,017,469 $153,093,487 $ $533,110,956
2020 $215,886,793 $275,000,000 $42,224,163 $533,110,956
2021 $0 $317,886,793 $215,224,163 $533,110,956
2022 $0 $285,603,168 $247,507,788 $533,110,956
2023 $0 $313,053,124 $288,100,478 $601,153,602
2024 $0 $733,317,426 $788,996,459 $1,522,313,885
2025 (submitted to CMS) $ $719,679,373 $820,744,321 $1,540,423,694
2026 (Estimate) $ $719,066,188 $844,121,178 $1,510,325,958

 

As an example, the payment allocation for the 2023 preprint is based on the hospital inpatient discharges and outpatient payments from managed care encounters paid in calendar year 2021. The final payments will be reconciled to the actual utilization during the rating period (July 1, 2022 through June 30, 2023) in April 2024 to allow for claims runout.

SFY 2026 MHAP Parameters

To request a copy of the MHAP model, send an email to the QIPP mailbox at QIPP@medicaid.ms.gov.

 

Quality Incentive Payment Program (QIPP)

The Quality Incentive Payment Program (QIPP) is part of the Mississippi Hospital Access Program (MHAP) and is made up of the following components: Potentially Preventable Hospital Returns (PPHR), Potentially Preventable Complications (PPC) and Health Information Network (HIN). For each component, an attestation form is required. The PPHR attestation form and the PPC attestation form require attesting to the receipt of the PPHR and PPC reports provided by DOM. These attestations are associated with the third month of each quarterly MHAP payment for QIPP during the state fiscal year. The HIN attestation indicates the hospital is connected to one of the two statewide HINs. The HIN attestation is associated with the first month of each quarterly MHAP payment for QIPP.

For SFY 2025, the Division of Medicaid (Division) has added the new quality metric of Ambulatory Potentially Preventable Complications (AM-PPC) into the Mississippi Hospital Access Program (MHAP). An attestation form will also be required. The AM-PPC attestation form requires attesting to the receipt of the AM-PPC report provided by DOM. The Division has been working with our outside contractors to produce the new AM-PPC reports. The reports are expected to be provided to hospitals in early January 2025.

For any further questions regarding this program, email the QIPP mailbox at QIPP@medicaid.ms.gov.

 

SFY 2025 QIPP Resources

SFY 2024 QIPP Resources

SFY 2023 QIPP Resources

SFY 2022 QIPP Resources

SFY 2020 QIPP Resources

 

Mississippi Outcomes for Maternal Safety (MOMS) Initiative

The Mississippi Division of Medicaid (DOM) is excited to announce the launch of the Mississippi Outcomes for Maternal Safety (MOMS) Initiative, a value-based payment (VBP) program designed to enhance maternal health outcomes statewide. This initiative addresses Mississippi’s persistently high rates of severe maternal morbidity (SMM) by incorporating a performance improvement model encouraging proactive care delivery through assessments and timely post-partum follow-up appointments. Below, we outline the program’s objectives, structure, and next steps to assist your team in preparing for participation.

This program is rooted in DOM’s commitment to improving maternal health through collaborative, evidence-based approaches, aligning hospitals, outpatient providers, Coordinated Care Organizations (CCO) and the broader healthcare system toward shared goals.

Transforming Reimbursement for Emergency Ambulance Transportation (TREAT)

In the 2022 regular legislative session, House Bill 657 authorized the additional payment program for ground emergency ambulance services to be funded with a health care provider fee. This state directed payment arrangement through managed care will be made quarterly to the eligible ground ambulance providers for SFY 2023. For more information regarding the TREAT program, please visit the following DOM site: https://medicaid.ms.gov/transforming-reimbursement-for-emergency-ambulance-transportation-treat/.

TREAT by SFY
SFY Status Amount
2023 Approved by CMS $14,740,472
2024 Approved by CMS $20,616,966
2025 Approved by CMS $25,285,224

 

The quality measures associated with this program are the following:

  • Maintain ground emergency ambulance providers in all of the Mississippi 82 counties;
  • Managed care utilization of ground emergency services; and
  • Identify existing sources of data for emergency ambulance provider performance measures to be able to identify future opportunities for quality improvement initiatives.

If you are a provider and have any questions regarding the TREAT program, email the TREAT mailbox at TREAT@medicaid.ms.gov.

 

Mississippi Medicaid Access to Physician Services (MS MAPS)

Mississippi Medicaid Access to Physician Services (MAPS) is a directed payment program developed in conjunction with the University of Mississippi Medical Center (UMMC). DOM received approval from CMS for the MAPS payments beginning in November 2019, and this program requires CMS approval annually. Much like MHAP, CCOs will be responsible for disbursing this additional funding to certain provider groups based on utilization of services.

The program is intended to increase access and quality of care for Medicaid beneficiaries to primary and specialty care services by increasing payments made to qualified practitioners employed by or affiliated with UMMC. UMMC will submit an Intergovernmental Transfer (IGT) for the state share of the payment.

MS MAPS by SFY
SFY Status Amount
2020 Payment $35,195,007
2021 Payment $37,239,856
2022 Approved by CMS $38,783,002
2023 Approved by CMS $38,018,361
2024 Approved by CMS $39,420,290
2025 Approved by CMS $29,526,177

 

This program is subject to six (6) quality measures for SFY 2025, which will be monitored by UMMC. Ten percent (10%) of the SFY 2025 payment is at-risk, meaning if the targets for any of the measures are not met, that portion of the at-risk payment will not be paid. The following are the quality measures for the MS MAPS program:

  1. Follow-Up After Hospitalization for Mental Illness – Adult (30-day)
  2. Follow-Up After Hospitalization for Mental Illness – Child (30 day)
  3. Tobacco Use: Screening and Cessation – Ages 18 and older
  4. Well Child Visits in the First 30 Months (Rate 1 only, First 15 months)
  5. Comprehensive Diabetes Care: Hemoglobin (HbA1c) Poor Control (>9.0%)
  6. Controlling High Blood Pressure (Hypertension)

 

Hospital Physician Directed Payment Arrangement

The Mississippi Division of Medicaid is working on the development of a new directed payment for physician services. This state directed payment arrangement would require a preprint approval by CMS. This program is authorized in Mississippi Code Section 43-13-117(A)(18)(b)(i) which allows DOM to pay additional payments for physician services for physicians who are either employed by or contracted with a hospital.

For any further questions regarding this program, email the QIPP mailbox at QIPP@medicaid.ms.gov.

 

Managed Care Value-Based Withhold Program

DOM has 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) measures, which are already being reported by the CCOs.

DOM has set a 1.0% withhold of capitation rates that began in SFY 2020 and requests approval annually for this program as part of the capitation rate certification performed yearly by CMS. These measures consist of mostly HEDIS measures which are based on prior Calendar Year and other measures including Hospital Readmissions for the respective CCO beneficiaries. For more information regarding the CCOs performance including a list of these performance metrics and results for each CCO for each year, please visit https://medicaid.ms.gov/programs/managed-care/measuring-managed-care-performance/.

 

Physician Quality Incentive Payment Program (PQIPP)

The PQIPP program development process did not result in a new payment program request to CMS.

 

Medicaid Presentations

 

Preprints

MHAP

MS MAPS

TREAT

 

Value-Based Incentives Archive

 

Posted byMatt Westerfield
November 12, 2019
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