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

SPOTLIGHT & RELEASES

11/19/2020: CMS released Quality Withhold Technical Notes for DY 2-8 for Illinois (rev. 11/19/2020). More information is available below.
10/29/2020: CMS released Quality Withhold Technical Notes for DY 2-6 for Texas. More information is available below. 
10/2/2020: CMS released Quality Withhold Technical Notes for DY 2-6, DY 2-7, & DY 2-8, for Michigan, New York (FIDA-IDD), & South Carolina, respectively. 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)
Page Last Modified:
12/01/2020 06:51 AM