The Mississippi Division of Medicaid (DOM) has requested authority from the Centers for Medicare and Medicaid Services (CMS) to undertake three new quality initiatives beginning in July 2019. These initiatives cover three major sources of Medicaid spending: hospitals, coordinated care organizations (CCOs), and the state’s academic medical center. All three include quality measures, targeted improvement levels and accountability.
Quality Incentive Payment Program (QIPP)
The Quality Incentive Payment Program (QIPP) is a new component DOM is adding to the Mississippi Hospital Access Program (MHAP) for hospitals. The goal of the QIPP is to utilize Medicaid supplemental funds to improve the quality of care and health status of the Mississippi Medicaid population. QIPP is envisioned to be a multi-year project with an increasing percentage of payments being linked to hospital performance. QIPP aims to reduce potentially preventable hospital readmission (PPR) rates by measuring those rates on a quarterly basis. DOM requested approval of this program as a part of the MHAP program.
Readmissions will be measured across all hospitals with the readmission being attributed to the original discharging hospital. The metric will exclude maternity and newborn readmissions. Also, the metric will include Emergency Department admissions for a condition related to a recent hospital discharge. The readmission rate metric will include all clinically related readmissions associated with a hospital discharge within the previous 15 days.
DOM will withhold 10% of the calculated MHAP payment for each hospital monthly. At the end of each quarter, hospitals meeting the criteria for payment will receive their withheld amount. The requirements for payment are planned to escalate over a three-year period. In the first year, the hospital must only attest to having received and reviewed their quarterly readmission report. Hospitals who fail to meet a certain threshold will be responsible for developing a corrective action plan and meeting improvement targets in future years. MHAP funds not distributed due to a hospital’s non-compliance with QIPP requirements will be distributed to the hospitals meeting those requirements.
Mississippi Medicaid Access to Physician Services (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 in November 2019. 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. Based on historical utilization of services, this program is projected to bring an increase in funding to UMMC of $24.4 million for SFY 2020 and $36.8 million for SFY 2021 while remaining budget neutral for the State.
Managed Care Value-Based Withhold Program
DOM is implementing a Managed Care Value-Based Withhold on MississippiCAN capitation rate payments. This quality withhold will be based on established quality metrics, such as Healthcare Effectiveness Data and Information Set (HEDIS) scores, which are already being reported by the CCOs.
DOM has set a 1% withhold of capitation rates for SFY 2020 and is requesting approval for this program as part of the capitation rate certification performed yearly by CMS.