Medicare-Medicaid Plan (MMP) Quality Withhold Methodology & Technical Notes

Medicare-Medicaid Plan (MMP) Quality Withhold Methodology & Technical Notes
SPOTLIGHT & RELEASES
02/05/2024: CMS released the revised Capitated Financial Alignment QW Methodology for Massachusetts, Michigan, Ohio, Rhode Island, & South Carolina for Demonstration Years 2-12 (accordingly). More information is available below.
01/11/2024: CMS released the revised Capitated Financial Alignment QW Methodology for Illinois, Texas, & New York (FIDA-IDD) for Demonstration Years 2-11 (accordingly). More information is available below.


MMPs participating in the capitated model will have a portion of their rates withheld; payment of these withheld amounts is subject to performance consistent with established quality requirements. The quality withhold analysis results for each demonstration will be posted to the state-specific pages as they become available.

More information on the Quality Withhold (QW) methodology and benchmarks is available below:

Additionally, information about the QW adjustment for extreme and uncontrollable circumstances (such as major natural disasters) and QW impacts due to the Coronavirus Disease 2019 (COVID-19) public health emergency (PHE) can be found in the memoranda below:

 

California

Illinois

Massachusetts

Michigan

New York - Fully Integrated Duals Advantage (FIDA)

New York - FIDA Intellectual and Development Disabilities (FIDA-IDD)

Ohio

Rhode Island

South Carolina

Texas

Virginia

(demonstration ended 12/31/2017)


Want regular email updates? Sign up by visiting this link.
We’re always looking for ways to improve the experience and usability of our webpages. If you’ve Feedback or issues to report, please contact us at MMCOWeb@cms.hhs.gov.
Page Last Modified:
09/10/2024 06:18 PM