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.
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|
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.
The October 2023 amendment to increase the 2023 preprint was based on a legislative requirement to include a border city university-affiliated pediatric teaching hospital in the payment program. The February 2023 amendment to the 2023 preprint requested an additional $40,245,451 be added to the program based on the outpatient payment average commercial rate (ACR).
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.
The PPHR baseline for the actual to expected ratio (A/E Ratio) is set at a statewide threshold of 1.04 (1.07 for Cycle 1 and Cycle 2). PPHR calculations include returns to a hospital for readmission or emergency department visit. If the hospitals A/E Ratio is above the statewide threshold, the hospital may be required to submit a Corrective Action Plan (CAP). Each year, the CAP is based on the July report results and is due September 1.
The PPC baseline for the A/E Ratio is set to 1.0 reviewing the hospital’s potentially preventable complications. If the hospital is above the A/E Ratio, the hospital may be required to submit a Corrective Action Plan (CAP). The first CAP submission will be due September 1, using the July report results of the same calendar year.
Both the PPHR and PPC components run in three-year cycles. As of January 2023, cycle two (2) has completed its three-year cycle for PPHR. The January 2023 PPHR report determined the results for those hospitals who were under a CAP for Cycle Two. If the required improvement was not met for the hospitals under a CAP, the hospital forfeited a percentage of the PPHR portion of QIPP funds for the 2023 state fiscal year based on the “at-risk” ratio tied to the hospital’s actual A/E Ratio. Those funds will be reallocated among the other hospitals in the MHAP program at the end of SFY 2023 along with any forfeited funds due to hospitals who did not submit an attestation form for PPHR, PPC and HIN or if a hospital did not participate in a HIN.
See the PPHR and PPC Training Webinar presentation under SFY 2024 QIPP Resources for more detailed information about each of the QIPP components.
For any further questions regarding this program, email the QIPP mailbox at QIPP@medicaid.ms.gov.
SFY 2024 QIPP Resources
- QIPP Schedule – SFY 2024
- SFY 2024 MS HIN Attestation
- QIPP PPHR and PPC Webinar Presentation July 2023
- SFY 2024 QIPP Provider Update Webinar Presentation Recording
- Methodology Supplements
- SFY 2023 Corrective Action Plans
SFY 2023 QIPP Resources
- QIPP PPHR and PPC Training Webinar_July 2022
- QIPP PPHR Corrective Action Plan SFY2022
- QIPP Schedule – SFY 2023 (Revised)
- SFY 2023 MS HIN Attestation
SFY 2022 QIPP Resources
- SFY 2022 QIPP Calendar
- MS QIPP PPC Methodology Supplement_June 2021
- MS QIPP PPHR Methodology Supplement Cycle 3 Update_June 2021
- QIPP PPHR and PPC Training Webinar_July 2021
- SFY22 Hospital QIPP_PPHR-PPC Attestation Form
- QIPP PPHR Corrective Action Plan SFY2021
- PPC Statewide Listing CY 2019-2020
- SFY 2022 MS HIN Attestation
SFY 2020 QIPP Resources
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|
|2023||Approved by CMS||$14,740,472|
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|
|2022||Approved by CMS||$38,783,002|
|2023||Approved by CMS||$38,018,361|
|2024||Approved by CMS||$39,420,290|
This program is subject to six (6) quality measures for SFY 2023 and is to be monitored by UMMC. The SFY 2023 payment is 5% at-risk meaning if the target for each measure is not met, that pro-rata portion of the at-risk portion for that 5% of the payment will be subject to not being paid. The following are the quality measures for the MS MAPS program:
- Follow-Up After Hospitalization for Mental Illness – Adult (30-day)
- Follow-Up After Hospitalization for Mental Illness – Child (30 day)
- Tobacco Use: Screening and Cessation – Ages 18 and older
- Well Child Visits in the First 30 Months (Rate 1 only, First 15 months)
- Comprehensive Diabetes Care: Hemoglobin (HbA1c) Poor Control (>9.0%)
- 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.
- HFMA 4-2023 Presentation
- HFMA 4-2022 Presentation
- HFMA 6-2021 Presentation
- MSCPA 09-2022 Presentation
- SFY 2018: Section-438.6c-Preprint-for-MHAP
- SFY 2019 MHAP Preprint Approval Letter
- SFY 2019 MHAP Preprint
- SFY 2020 MHAP Preprint Approval Letter
- SFY 2020 MHAP Preprint
- SFY 2021 MHAP Preprint Approval Letter
- SFY 2021 MHAP Preprint
- SFY 2022 MHAP Preprint
- SFY 2023 MHAP Preprint
- SFY 2024 MHAP Preprint
- SFY 2020 MS MAPS Preprint Approval Letter
- SFY 2020 MS MAPS Preprint
- SFY 2021 MS MAPS Preprint
- SFY 2022 MS MAPS Preprint
- SFY 2023 MS MAPS Preprint
- SFY 2024 MS MAPS Preprint
Autism Spectrum Disorder