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

SPOTLIGHT & RELEASES

04/04/2019 - Quality Withhold Adjustment for Extreme and Uncontrollable Circumstances (04/01/2019)

02/05/2019 - Capitated Financial Alignment Demonstration Years 2-6 QW Methodology for Massachusetts


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) can be found in the memorandum 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)