NASHP

State Medicaid Quality Measurement Activities for Women’s Health

Updated October 2019

State Medicaid agencies provide a variety of health services to promote women’s overall health and improve birth outcomes, such as reducing infant mortality. States use performance measurement, incentives, and other improvement initiatives to enhance preventive care, chronic disease management, and perinatal care. This map and downloadable chart highlight states’ managed or accountable care performance improvements and system transformation initiatives used to improve women’s health.

Acknowledgement: This chart is a publication of the National Academy for State Health Policy (NASHP). This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services HHS under the Supporting Maternal and Child Health Innovation in States Grant No. U1XMC31658; $398,953. This information, content, and conclusions are those of the authors’ and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the US government.

Notes

*The 2019 information NASHP compiled about this state has not yet been confirmed by the state’s Medicaid agency.

Sources include state quality strategy documents, external quality reports, and correspondence with state Medicaid officials. Italicized items are in a proposed or pending status.

Please email feedback, additions, and edits to efernandez@nashp.org.

*The 2019 information NASHP compiled about this state has not yet been confirmed by the state’s Medicaid agency.

Note: Sources include state quality strategy documents, external quality reports, and correspondence with state Medicaid officials. Italicized items are in a proposed or pending status.

Endnotes

[1] AL: Evaluates key performance measures (e.g., postpartum care, frequency of ongoing prenatal care, and timeliness of prenatal care/early prenatal care entry) for pregnant women once their Regional Care Organizations are implemented in October 2017.

[2] AL: https://www.medicaid.alabama.gov/documents/2.0_Newsroom/2.7_Special_Initiatives/2.7.6_ACHN/2.7.6_Overview_Proposed_ACHN_12-19-18.pdf

[3] AK: https://dhss.alaska.gov/HealthyAlaska/Documents/redesign/2018-MCD-ReformQuality-CostTargetReport.pdf

[4] AK: The Medicaid Redesign Quality and Cost Effectiveness Targets Stakeholder Workgroup identified the following potential future Medicaid measures: alcohol use screenings and HIV screenings for pregnant women, pending passage of preventative services regulations, and BHRA for pregnant women, pending the identification of a consistent data source

[5] AZ: CYE 2017 Performance Measure Crosswalk, https://www.azahcccs.gov/resources/Downloads/PerformanceMeasures/CYE2017_PerformanceMeasureCrosswalk.pdf

[6] AZ: https://www.azahcccs.gov/resources/Downloads/PerformanceMeasures/CYE2019PerformanceMeasureCrosswalk.pdf

[7] AR: Episode of Care: Perinatal Care Episode Design Summary 2017, https://www.paymentinitiative.org/episodesOfCare/Documents/Episode%20Design%20Summary%20-%20PERINATAL%20-%202017-01-17.pdf

[8] AR: https://afmc.org/wp-content/uploads/2018/08/IQI_Manual-SFY2019_20180702v1.0FINAL.pdf

[9] AR: https://www.paymentinitiative.org/Websites/paymentinitiative/images/EOC%20Documents/EOC%20Design%20Summaries/Episode%20Design%20Summary%20-%20Perinatal%20-%201-22-2019.pdf

[10] AR: In the perinatal episode of care, a minimum threshold of 80% of episodes must include HIV screening and chlamydia screening to be linked to gain sharing eligibility for the Principal Accountable Provider.

[11] CA: Medi-Cal covers intimate partner violence screening for women of reproductive age https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/prev_m01o03.doc. See also, https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/

[12] CA: With some of the revenue generated from the California Healthcare, Research and Prevention Tobacco Tax Act (Proposition 56), California provides supplemental payments for certain ccomprehensive family planning services, including contraceptives. See, https://www.dhcs.ca.gov/formsandpubs/laws/Documents/SPA19-0027PublicNotice.pdf. Also see,  https://www.dhcs.ca.gov/formsandpubs/laws/Documents/SPA19-0040PublicNotice.pdf.

[13] CA: 2011 Medi-Cal Birth Statistics https://www.dhcs.ca.gov/dataandstats/statistics/Documents/22_Birth_Report_2011.pdf

[14] CA: https://www.dhcs.ca.gov/dataandstats/reports/Documents/MMCD_Qual_Rpts/Studies_Quality_Strategy/2017_Medi-Cal_Managed_Care_Quality_Strategy_Annual_Assessment.pdf

[15] CA: 2011 Medi-Cal Birth Statistics https://www.dhcs.ca.gov/dataandstats/statistics/Documents/22_Birth_Report_2011.pdf

[16] CA: P4P program for Tdap as of 7/1/2019

[17] CA: Hepatitis C screenings available for adolescents and adults

[18] CA: Nine health plans conducted PIPs on the topic of timely postpartum visit care in 2015. The Community Health Group Partnership Plan offers members a $25 incentive gift card for completing a postpartum visit during required time frame. California Department of Health Care Services Medi-Cal Managed Care Quality Strategy Comprehensive Review October 2016, https://www.dhcs.ca.gov/dataandstats/reports/Documents/MMCD_Qual_Rpts/Studies_Quality_Strategy/QualityStrategyRpt_2016.pdf

[19] CA: https://www.dhcs.ca.gov/dataandstats/reports/Documents/MMCD_Qual_Rpts/TechRpt/CA2016-17_EQR_Technical_Report_F1.pdf

[20] CA: PIP aims to improve timeliness of prenatal and postpartum care. Prenatal and Postpartum Care–Timeliness of Prenatal Care, https://www.dhcs.ca.gov/dataandstats/Pages/PrenatalandPostpartumCare.aspx

[21] CA: P4P Value Based Program as of 7/1/2019

[22] CA: https://www.dhcs.ca.gov/dataandstats/Pages/CMSInitialChildCoreSet.aspx

[23] CA: P4P Value Based Program as of 7/1/2019

[24] CA: Quality Metric (CMS Core Set)

[25] CA: Medi-Cal Managed Care Health Plans Chlamydia Screening in Women and Data Validation Study, https://www.dhcs.ca.gov/dataandstats/reports/Documents/MMCD_Qual_Rpts/Studies_Quality_Strategy/Chlamydia_Study_CA.pdf and DHCS Strategy for Quality Improvement in Health Care 2016, https://www.dhcs.ca.gov/services/Documents/DHCS_Quality_Strategy_2016.pdf

[26] CA: Medi-Cal covers sexually transmitted infections counseling, as well as HIV, Hepatitis B, Gonorrhea, and Chlamydia screening, as a USPSTF grade A/B recommendation.  https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/prev_m01o03.doc. See also, https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/

[27] CA: https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/prev_m01o03.doc. See also, https://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations/

[28] CO: Colorado Medicaid Health Specific Measures 2016 Data Report, https://www.colorado.gov/pacific/sites/default/files/2016%20QHI%20Data%20Report.pdf

[29] CO: https://www.colorado.gov/pacific/sites/default/files/2019%20May%202019%20HQIP%20Program%20Details.pdf

[30] CO: Breast Cancer Screening measures part of Primary Care APM https://www.colorado.gov/pacific/hcpf/primary-care-payment-reform-3

[31] CO: Maternal emergencies and exclusive breastfeeding measures as part of Hospital Quality Incentive Payment Program https://www.colorado.gov/pacific/sites/default/files/2019%20May%202019%20HQIP%20Program%20Details.pdf

[32] CO: Public reporting of early elective deliveries and payment on cesarean section rates https://www.colorado.gov/pacific/sites/default/files/2019%20May%202019%20HQIP%20Program%20Details.pdf

[33] CO: https://www.colorado.gov/pacific/hcpf/primary-care-payment-reform-3 https://www.colorado.gov/pacific/sites/default/files/Supporting%20a%20Culture%20of%20Coverage%20Accountable%20Care%20Collaborative%202014-15%20Annual%20Report.pdf

[34] CO: https://www.colorado.gov/pacific/hcpf/primary-care-payment-reform-3

[35] CO: https://www.colorado.gov/pacific/sites/default/files/Prenatal%20and%20Post-Partum%20Care.pdf

[36] CO: https://www.colorado.gov/pacific/sites/default/files/2018%20Quality%20Strategy%20-Final.pdf

[37] CO: Health First Colorado’s (Medicaid) Prenatal Plus Program is a prenatal service program for high-risk pregnant women. Medicaid collects data on enrollees’ amount of smoking in the first and last trimesters of pregnancy.

[38] CT: The 2019 annual performance incentives for medical administrative services organizations have a number of goals to improve maternal outcomes, notably controlling hypertension among pregnant and post-partum women

[39] CT: Introduced third pay for performance program in obstetrics care to perform a full term, spontaneous vaginal delivery, https://www.huskyhealthct.org/providers/provider_postings/2018-28ObstetricsPayForPerformanceProgram.pdf

[40] CT: Amerigroup’s PIP aimed to increase the number of new mothers that had a postpartum visit on or before 21 and 56 days after delivery. Connecticut Performance Improvement Projects Status Report 2011, https://www.cga.ct.gov/med/council/2011/0114/20110114ATTACH_AmeriChoice%20PIPs%20Presentation.pdf

[41] CT: Amerigroup’s PIP aimed to increase the percentage of mothers who had greater than 81% of expected prenatal visits. Connecticut Performance Improvement Projects Status Report 2011, https://www.cga.ct.gov/med/council/2011/0114/20110114ATTACH_AmeriChoice%20PIPs%20Presentation.pdf

[42] CT: https://providers.amerigroup.com/ProviderDocuments/NJNJ_CAID_QualityProviderNewsletterUpdate.pdf

[43] CT: Amerigroup’s PIP aimed to increase the percentage of pregnant members who received a prenatal care visit in the first trimester, or within 42 days of enrollment into the health plan. Connecticut Performance Improvement Projects Status Report 2011, https://www.cga.ct.gov/med/council/2011/0114/20110114ATTACH_AmeriChoice%20PIPs%20Presentation.pdf

[44] CT: Ob pay-for-performance is going to emphasize post-partum follow-up including use of LARC beginning July 1st, 2019

[45] DE: https://www.dhss.delaware.gov/dmma/files/2017_eqro_compliance_report.PDF

[46] DC: Currently pending approval of Medicaid 1115 Behavioral Health Transformation Waiver https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/page_content/attachments/1115%20Final%20Demonstration%20Application%206.3.19%20.pdf

[47] DC: Performance improvement project starting in 2019

[48] DC: The Patient Centered Maternal Care Program will support health care providers to initiate or enhance a peer navigation program directed towards improving perinatal health services among high-risk expectant mothers in Wards 7 & 8 who are on Medicaid or are Medicaid-eligible https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/publication/attachments/Patitent%20Centered%20Maternal%20Care%20Program%20RFA%20%282019%29.pdf

[49] DC: The Patient Centered Maternal Care Program will support health care providers to initiate or enhance a peer navigation program directed towards improving perinatal health services among high-risk expectant mothers in Wards 7 & 8 who are on Medicaid or are Medicaid-eligible https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/publication/attachments/Patitent%20Centered%20Maternal%20Care%20Program%20RFA%20%282019%29.pdf

[50] DC: Performance improvement project starting in 2019

[51] DC: The Patient Centered Maternal Care Program will support health care providers to initiate or enhance a peer navigation program directed towards improving perinatal health services among high-risk expectant mothers in Wards 7 & 8 who are on Medicaid or are Medicaid-eligible https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/publication/attachments/Patitent%20Centered%20Maternal%20Care%20Program%20RFA%20%282019%29.pdf

[52] DC: Performance improvement project starting in 2020

[53] DC also participates in the Enabling Access to Family Planning TA initiative funded by Arnold Ventures

[54] https://dhcf.dc.gov/sites/default/files/dc/sites/dhcf/publication/attachments/FY%202017%20Annual%20Technical%20Report_FINAL.pdf

[55] FL: https://ahca.myflorida.com/Medicaid/statewide_mc/index.shtml

[56] FL: One of the four Agency-approved statewide performance improvement projects focus on improving primary C-section rates, pre-term delivery rates, and neonatal abstinence syndrome rates  https://ahca.myflorida.com/Medicaid/statewide_mc/pdf/Contracts/2019-02-01/Exhibit_II_A-MMA_2019-02-01.pdf

[57] FL: Health plans are required to report on the postpartum care HEDIS measure and implement validated PIPs on this topic. Additionally, in order to reduce poor birth outcomes, health plans are required to provide prenatal services such as nutrition counseling and tobacco cessation support. 2017 Comprehensive Quality Strategy, https://www.fdhc.state.fl.us/medicaid/Policy_and_Quality/Quality/docs/CQS_Final_Draft_2017_03-02-2017.pdf

[58] FL: Health plans are required to report on the timeliness of prenatal care HEDIS measure and implement validated PIPs on this topic. Additionally, in order to reduce poor birth outcomes, health plans are required to provide prenatal services such as nutrition counseling and tobacco cessation support. 2017 Comprehensive Quality Strategy, https://www.fdhc.state.fl.us/medicaid/Policy_and_Quality/Quality/docs/CQS_Final_Draft_2017_03-02-2017.pdf

[59] FL: Health plans are required to report on the timeliness of prenatal care HEDIS measure and implement validated PIPs on this topic. Additionally, in order to reduce poor birth outcomes, health plans are required to provide prenatal services such as nutrition counseling and tobacco cessation support. 2017 Comprehensive Quality Strategy, https://www.fdhc.state.fl.us/medicaid/Policy_and_Quality/Quality/docs/CQS_Final_Draft_2017_03-02-2017.pdf

[60] GA: Georgia Department of Community Health Quality Strategy 2016, https://dch.georgia.gov/sites/dch.georgia.gov/files/2016-Quality-Strategic-Plan-Final-6.17.16.pdf

[61] GA: https://dch.georgia.gov/sites/dch.georgia.gov/files/GA2017-18_EQR_TechRpt_F1.pdf

[62] GA: To improve member outreach and education, one Care Management Organization (CMO) implemented the following: reminder calls for scheduled postpartum appointments; provided members an incentive for completing a timely visit; and a “maternity rewards program” where members could select a stroller or play yard after completing of a timely postpartum visit. Member outreach was facilitated by OB social workers.

[63] GA: In 2015, three CMOs (Amerigroup Community Care, Peach State Health Plan, and WellCare of Georgia Inc.) implemented PIPs to improve postpartum visit rates.

[64] ID: Idaho Statewide Healthcare Innovation Plan, https://healthandwelfare.idaho.gov/Portals/0/Medical/SHIP/IdahoSHIP.pdf

[65] ID: https://ship.idaho.gov/Portals/93/Documents/DGW/2017%20Meetings/SHIPCQMDetails-v1F-20170609.pdf?ver=2017-06-12-092014-287

[66] IL: Hospital billing and reimbursement for immediate postpartum LARCs updated July 1st, 2015 https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn150630a.aspx

[67] IL: Smoking cessation services for pregnant women are covered for pregnant women on a face-to-face basis

[68] IL: https://www.illinois.gov/hfs/SiteCollectionDocuments/FINAL2015CCSDbk9-26-16.pdf

[69] IL: The primary aim of the PIP is to improve the timeliness of prenatal care and postpartum care. A secondary aim is to improve the percentage of women who are screened for depression and receive the appropriate treatment during the prenatal and/or postpartum period. To improve member outreach, a MCO conducted hospital discharge follow-up calls to assist women with scheduling a postpartum visit and arrange transportation. 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, https://www.medicaid.gov/medicaid/quality-of-care/downloads/2015-child-sec-rept.pdf

[70] IL: https://www.illinois.gov/hfs/SiteCollectionDocuments/IL2018QualityStrategyF1.pdf

[71] IL: CHIPRA Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP: Illinois’ Performance CY 2009-2012, https://www.illinois.gov/hfs/SiteCollectionDocuments/20092012CHIPRADatabook.pdf

[72] IL: The primary aim of the PIP is to improve the timeliness of prenatal care and postpartum care. A secondary aim is to improve the percentage of women who are screened for depression and receive the appropriate treatment during the prenatal and/or postpartum period. MCOs also implemented incentive programs to increase the number of prenatal visits, such as gift cards, coupons for a free baby photo, and a rewards program for participants who completed the recommended number of visits. Two MCOs implemented a provider incentive program that paid providers for notifying the MCO of pregnant members. 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, https://www.medicaid.gov/medicaid/quality-of-care/downloads/2015-child-sec-rept.pdf

[73] IL: CHIPRA Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP: Illinois’ Performance CY 2009-2012, https://www.illinois.gov/hfs/SiteCollectionDocuments/20092012CHIPRADatabook.pdf

[74] IN: prohibition of reimbursement for early elective deliveries https://www.in.gov/fssa/hip/files/2018-03-20-QSP-Plan-final.pdf

[75] IA: https://dhs.iowa.gov/sites/default/files/Public%20Reporting%20of%20Measures%20for%20adult%20meausres%20(2)_0.pdf?021520191753

[76] IA: https://dhs.iowa.gov/sites/default/files/Annualreport2018_Final_0.pdf?021520191758

[77] KS: https://www.kancare.ks.gov/docs/default-source/policies-and-reports/quality-measurement/hedis-2017-faqs-20161212.pdf?sfvrsn=de2d4b1b_4

[78] KS: https://www.kancare.ks.gov/docs/default-source/about-kancare/kancare-renewal-forums/kancare-renewal/kancare-2-0-demonstration-renewal-application-(002).pdf?sfvrsn=4

[79] KY: Kentucky currently has 4 PIPs on postpartum care and a state specific performance measure on Prenatal and Postpartum Risk Assessment and Education/Counseling. All 5 MCOs report HEDIS measures including: Breast Cancer Screening, Cervical Cancer Screening, Chlamydia Screening, Timeliness of Prenatal Care, Postpartum Care, Frequency of Prenatal Care, Maternity Discharges/1000MM, OBGYN Board Certification, Weeks of Pregnancy at Time of Enrollment, and Non-Recommended Cervical Cancer Screening. KY offers member screening incentives, gift cards for prenatal rewards, cribs, diaper bags, car seats and free baby showers, and MCO incentives related to prenatal care.

[80] KY: The Department of Medicaid Services conducted a study on prenatal smoking to assess smoking prevalence among the Medicaid Managed Care population and evaluate prenatal and postpartum interventions. Commonwealth of Kentucky Department for Medicaid Services Division of Program Quality and Outcomes Focused Study: Prenatal Smoking, https://chfs.ky.gov/NR/rdonlyres/5C8A00D0-F72D-4756-9BCA-4CD56B103B61/0/KY_Prenatal_Smoking_Study_Final71216.pdf

[81] LA: https://ldh.la.gov/assets/docs/BayouHealth/CompanionGuides/LA_QCG_MCO.pdf

[82] ME: The state is not tracking or reporting this information.

[83] ME: MaineCDC released an update of the “Snuggle ME Guidelines: Tools for Caring for Women with Addiction and Their Babies” in 2018

[84] ME: MaineCare opened a code to reimburse for opioid use disorder screening

[85] ME: Cervical Cancer Quality Indicator: https://www.maine.gov/dhhs/oms/pdfs_doc/pccm/pccm_enroll/PCPIPQualityIndicators_FINAL100512%20.pdf

[86] ME: https://www.maine.gov/dhhs/oms/pdfs_doc/pccm/pccm_enroll/PCPIPQualityIndicators_FINAL100512%20.pdf

[87] ME: MaineCare and MaineCDC have partnered together for the past two years on an Innovation Accelerator Program project to increase OUD screening and treatment for pregnant women

[88] MD: Preventative and Restorative — Statewide Executive Summary Health Choice Participating Organizations HEDIS 2015, https://mmcp.dhmh.maryland.gov/healthchoice/Documents/DHMH%202015%20HEDIS%20Executive%20Summary%20Report.pdf

[89]  MD: https://mmcp.health.maryland.gov/healthchoice/Documents/Statewide%20Executive%20Summary%20Report%20HealthChoice%20Participatin%20Organizations%20HEDIS%202018.pdf

[90] MD: Statewide Executive Summary Health Choice Participating Organizations HEDIS 2015, https://mmcp.dhmh.maryland.gov/healthchoice/Documents/DHMH%202015%20HEDIS%20Executive%20Summary%20Report.pdf

[91] MD: Statewide Executive Summary Health Choice Participating Organizations HEDIS 2015, https://mmcp.dhmh.maryland.gov/healthchoice/Documents/DHMH%202015%20HEDIS%20Executive%20Summary%20Report.pdf

[92] MD: Statewide Executive Summary Health Choice Participating Organizations HEDIS 2015, https://mmcp.dhmh.maryland.gov/healthchoice/Documents/DHMH%202015%20HEDIS%20Executive%20Summary%20Report.pdf

[93] MA: MassHealth implemented a separate service payment for perinatal depression screening in 2016. See https://www.mass.gov/lists/transmittal-letters-by-year for 2016 provider transmittal letters AOH-37, PHY-148, and CHC-105 implementing payment; and 2017 current transmittal letters AOH-42, PHY-153, and CHC-110.

[94] MA: The MassHealth Acute Hospital Pay-for-Performance program includes a cesarean birth measure.  See Rate Year 2019 Acute Hospital Request for Applications § 7.3, excerpts of which are available at https://www.mass.gov/files/documents/2018/10/30/notice-of-final-agency-action-mh-payment-for-in-state-acute-hospital-services-and-out-of-state-acute-hospital-services-effective-11-01-18.pdf.

[95] MA: All contracted MCOs and Accountable Care Partnership Plan ACOs are required to collect and report the Postpartum visit rate as part of their required HEDIS reporting. Additionally, MassHealth collects and reports on the postpartum visit rate for their PCC Plan..

[96] MA: Timeliness of prenatal care one performance measure for the MassHealth PCC Plan, MCO, and ACO programs.  Specifically for ACOs, performance on this measure will be integrated into quality and accountability scores that may impact ACO payments.  .

[97] MA: PIP aims to increase contraceptive use by women ages 15-44 and contraceptive use postpartum.

[98] MI: Several Michigan Health Plans implemented PIPs to improve postpartum care. To improve performance on HEDIS measures, Meridian Health Plan offers financial incentives to providers for completing a postpartum visit between 21-56 days. 2013-2014 External Quality Review Technical Report for Medicaid Health Plans, https://www.michigan.gov/documents/mdhhs/MI2013-14_PH-MHP_EQR-TR_Sec1-3_F1_552683_7.pdf and Meridian Health Plan Obstetrical Care Bonus Program, https://corp.mhplan.com/ContentDocuments/default.aspx?x=HLNCAF7d82a7l6Vcr53yuPVy/2ffa7F3BWfyR47pFPJYvn10onPttylEtOYHBVl14jV62jAQmL7B2Kf1nmMJEA

[99] MI: https://www.michigan.gov/documents/mdhhs/MI2018_HEDIS-Aggregate_Report_F1_638961_7.pdf

[100] MI: To improve performance on HEDIS measures, Meridian Health Plan offers financial incentives to providers for completing prenatal visits. Meridian Health Plan Obstetrical Care Bonus Program, https://corp.mhplan.com/ContentDocuments/default.aspx?x=HLNCAF7d82a7l6Vcr53yuPVy/2ffa7F3BWfyR47pFPJYvn10onPttylEtOYHBVl14jV62jAQmL7B2Kf1nmMJEA

[101] MI: Several Michigan Health Plans implemented PIPs to improve timeliness of prenatal care. 2013-2014 External Quality Review Technical Report for Medicaid Health Plans, https://www.michigan.gov/documents/mdhhs/MI2013-14_PH-MHP_EQR-TR_Sec1-3_F1_552683_7.pdf

[102] MI: 2013-2014 External Quality Review Technical Report for Medicaid Health Plans, https://www.michigan.gov/documents/mdhhs/MI2013-14_PH-MHP_EQR-TR_Sec1-3_F1_552683_7.pdf

[103] MN Integrated Care for High-Risk Pregnant Women – program for women in medical assistance at high risk for adverse outcomes of pregnancy

[104] https://medicaid.ms.gov/wp-content/uploads/2018/06/Managed-Care-Quality-Strat-and-Appendices-Initial-Draft-6.21.18.pdf

[105] MO: https://dss.mo.gov/mhd/mc/pdf/2018-quality-strategy.pdf

[106] MT: Perinatal Behavioral Health Initiative is a public-private partnership that awards providers who work closely with pregnant and postpartum women experiencing behavioral health issues https://dphhs.mt.gov/aboutus/news/2018/perinatalbehavioralhealthinitiative

[107] MT: Perinatal Behavioral Health Initiative is a public-private partnership that awards providers who work closely with pregnant and postpartum women experiencing behavioral health issues https://dphhs.mt.gov/aboutus/news/2018/perinatalbehavioralhealthinitiative

[108] MT: Perinatal Behavioral Health Initiative is a public-private partnership that awards providers who work closely with pregnant and postpartum women experiencing behavioral health issues https://dphhs.mt.gov/aboutus/news/2018/perinatalbehavioralhealthinitiative

[109] NE: https://dhhs.ne.gov/medicaid/Documents/Quality%20Strategy%20for%20Heritage%20Health%20and%20the%20Medicaid%20Dental%20Benefit%20Program%202017.pdf

[110] NV: https://dhcfp.nv.gov/uploadedFiles/dhcfpnvgov/content/Members/BLU/NV2016-17_QAPIS_Report_F1.pdf

[111] NH: https://medicaidquality.nh.gov/measures-a-z-list

[112] NJ: Amerigroup’s PIP aims to increase the rate of dental visits in pregnant enrollees.

[113] NJ: Division of Medical Assistance and Health Services Quality Strategy 2014, https://www.state.nj.us/humanservices/dmahs/home/MLTSS_Quality_Strategy-CMS.pdf

[114] NJ: https://www.state.nj.us/humanservices/dmahs/news/Medicaid_MLTSS_Quality_Report_2016-2017.pdf

[115] NJ: Division of Medical Assistance and Health Services Quality Strategy 2014, https://www.state.nj.us/humanservices/dmahs/home/MLTSS_Quality_Strategy-CMS.pdf

[116] NJ: Division of Medical Assistance and Health Services Quality Strategy 2014, https://www.state.nj.us/humanservices/dmahs/home/MLTSS_Quality_Strategy-CMS.pdf

[117] NJ: Division of Medical Assistance and Health Services Quality Strategy 2014, https://www.state.nj.us/humanservices/dmahs/home/MLTSS_Quality_Strategy-CMS.pdf

[118] NM: https://www.hsd.state.nm.us/providers/2017-nm-quality-strategy-final.pdf

[119] NM:  Prenatal and postpartum care are required MCO performance measures. External Quality Review of Centennial Care Performance Management Programs Performance Improvement Projects, State Fiscal Year 2016, https://www.hsd.state.nm.us/uploads/FileLinks/8087bfcd31b14dfe8b92a6206b890b19/EQRO_SFY2016_PM_PIP_Final_Report.pdf. Previously NM had a PIP to improve the percentage of women who delivered a live birth who had a postpartum visit on or between 21 and 56 days after delivery.

[120] NM: Frequency of ongoing prenatal care is a required MCO performance measure. The state also previously had a PIP that aimed to improve the frequency of prenatal visits to improve birth outcomes. External Quality Review of Centennial Care Performance Management Programs Performance Improvement Projects, State Fiscal Year 2016, https://www.hsd.state.nm.us/uploads/FileLinks/8087bfcd31b14dfe8b92a6206b890b19/EQRO_SFY2016_PM_PIP_Final_Report.pdf

[121] NY: https://www.health.ny.gov/health_care/managed_care/qarrfull/qarr_2018/docs/qarr_specifications_manual.pdf

[122] NY: PIP Includes use of 17-alpha hydroxyprogesterone caproate (17P) to reduce the risk of recurrent preterm birth

[123] NY: All Plan Summary Report for New York State Medicaid Managed Care Organizations 2015, https://www.health.ny.gov/statistics/health_care/managed_care/plans/reports/docs/all_plan_summary.pdf

[124] NY: https://health.ny.gov/health_care/managed_care/reports/docs/quality_incentive/quality_incentive_2017.pdf

[125] NY: All Plan Summary Report for New York State Medicaid Managed Care Organizations 2015, https://www.health.ny.gov/statistics/health_care/managed_care/plans/reports/docs/all_plan_summary.pdf

[126] NC: Community Care of North Carolina Pregnancy Medical Home, https://www.ccwjc.com/pregnancy%20medical%20home.asp

[127] NC: NC’s Babybook is used through NC DHHS to monitor maternal and child health https://schs.dph.ncdhhs.gov/data/vital/babybook/2017/toc.htm

[128] NC: Care Needs Screening https://files.nc.gov/ncdma/documents/NC-Medicaid-Managed-Care-Quality-Measurement-Technical-Specifications-Public.pdf

[129] NC: https://files.nc.gov/ncdma/documents/NC-Medicaid-Managed-Care-Quality-Measurement-Technical-Specifications-Public.pdf

[130] NC: https://files.nc.gov/ncdma/documents/NC-Medicaid-Managed-Care-Quality-Measurement-Technical-Specifications-Public.pdf

[131] NC: https://files.nc.gov/ncdhhs/documents/PHP-QualityPerformance-and-Accountability_ConceptPaper_FINAL_20180320.pdf

[132] NC: https://files.nc.gov/ncdhhs/documents/DRAFT_QualityStrategy_20180320.pdf

[133] NC: https://files.nc.gov/ncdma/documents/NC-Medicaid-Managed-Care-Quality-Measurement-Technical-Specifications-Public.pdf

[134] NC: https://files.nc.gov/ncdhhs/documents/PHP-QualityPerformance-and-Accountability_ConceptPaper_FINAL_20180320.pdf

[135] NC: https://files.nc.gov/ncdma/documents/NC-Medicaid-Managed-Care-Quality-Measurement-Technical-Specifications-Public.pdf

[136] OH: Introduction to Ohio’s Episode-Based Payment Model 2015, https://www.healthtransformation.ohio.gov/LinkClick.aspx?fileticket=effiGhaJYNQ%3D&tabid=226 and Medicaid quality metrics and spend thresholds after inflationary adjustments for performance period 1, 2016 – Perinatal, https://www.medicaid.ohio.gov/Portals/0/Providers/PaymentInnovation/Threshold/Perinatal-Thresholds.pdf and Patient Journey, Perinatal Episode, https://medicaid.ohio.gov/Portals/0/Providers/PaymentInnovation/DEF/Perinatal.pdf

[137] OH: Difference between Principal Accountable Provider average risk-adjusted episode reimbursement and commendable cost threshold (for a positive incentive) or acceptable cost threshold (negative incentive). State threshold: perinatal rate must have average risk-adjusted perinatal episode cost below $3210 for positive incentives and Principal Accountable Providers with average episode cost above $4405 incur negative incentive. Introduction to Ohio’s Episode-Based Payment Model 2015, https://www.healthtransformation.ohio.gov/LinkClick.aspx?fileticket=effiGhaJYNQ%3D&tabid=226

[138] OH: https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/gestational-diabetes/improvement-initiatives

[139] OH: https://procure.ohio.gov/pdf/1535771320189459Performance%20Scorecard.pdf

[140] OH: https://medicaid.ohio.gov/Portals/0/Providers/PaymentInnovation/DEF/Perinatal.pdf

[141] OH: Comprehensive Primary Care (CPC) clinical quality measure, https://medicaid.ohio.gov/Portals/0/Providers/PaymentInnovation/CPC/qualityMetricSpecs.pdf

[142] OK: 2018 – Quality of Care in the SoonerCare Program Report – Quality Measures (2017) https://www.okhca.org/research.aspx?id=87&parts=7447

[143] OK: SFY 2019 Quality Improvement Plan https://okhca.org/xQualityImprovement.aspx?id=22208&blogid=90195

[144] OR: Oregon’s Health System Transformation: CCO Metrics 2015 Final Report, https://www.oregon.gov/oha/Metrics/Documents/2014%20Final%20Report%20-%20June%202015.pdf and Oregon Health Authority Measure Sets, https://www.oregon.gov/oha/analytics/CCOData/2017%20Measures.pdf

[145] OR: To receive incentive payments, a CCO must meet the performance threshold for any 12 of the incentive metrics and have at least 60 percent of their members enrolled in a PCMH (known as a Patient Centered Primary Care Home or PCPCH in Oregon).

[146] OR: Three CCO’s (Intercommunity Health, PS Columbia George, and PS Central Oregon) implemented PIPs on oral health visits among pregnant members. CCO Performance Improvement Projects 2016, https://www.oregon.gov/oha/analytics/MetricsDocs/PIPs_Summary.pdf

[147] OR: Three CCO’s (Cascade Health Alliance, Columbia Pacific, and Jackson Care Connect) implemented PIPs to improve performance on timeliness of prenatal care. CCO Performance Improvement Projects 2016,  https://www.oregon.gov/oha/analytics/MetricsDocs/PIPs_Summary.pdf

[148] OR: CCOs use incentive metrics to address timeliness of prenatal care, https://www.oregon.gov/oha/analytics/CCOData/2016%20Measures.pdf and https://www.oregon.gov/oha/analytics/CCOData/Prenatal%20Care%20Guidance%20Document%20–%20revised%20July%202014.pdf

[149] OR: https://www.oregon.gov/oha/HSD/Medicaid-Policy/Documents/Oregon%20Health%20Plan%20STCs_2017-2022.pdf

[150] OR: CCOs use incentive metrics to address prenatal care through effective contraceptive use. https://www.oregon.gov/oha/analytics/CCOData/2016%20Measures.pdf and https://www.oregon.gov/oha/analytics/CCOData/Effective%20Contraceptive%20Use%20Guidance%20Document.pdf

[151] OR: All Care’s PIP aims to increase the percentage of referrals to community substance abuse treatment programs for pregnant members. Umpqua Health Alliance’s PIP and Health Share’s PIP aim to improve performance on identification of addiction issues in pregnancy. CCO Performance Improvement Projects 2016, https://www.oregon.gov/oha/analytics/MetricsDocs/PIPs_Summary.pdf

[152] PA: Along with performance measure, information is also collected via Obstetrics Needs Assessment Form

[153] RI: https://www.ohic.ri.gov/documents/FINAL-Crosswalk-of-RI-Aligned-Measure-Sets-For-2019.xlsx

[154] SC: South Carolina Screening Brief Intervention and Referral Treatment (SBIRT),  https://www.scdhhs.gov/organizations/screening-brief-intervention-and-referral-treatment-sbirt

[155] SC: https://msp.scdhhs.gov/pcc/

[156] SC: https://www.scdhhs.gov/organizations/south-carolina-birth-outcomes-initiative

[157] SC: https://msp.scdhhs.gov/managedcare/sites/default/files/SCEQR_Compreshensive%20Annual%20Technical%20Report%202017-2018.pdf

[158] TN: BABY & ME—Tobacco Free Program is an evidence-based, smoking cessation program created to reduce the burden of tobacco on pregnant and postpartum people https://www.tn.gov/tenncare/tenncare-s-opioid-strategy.html

[159] TN: Screening for gestational diabetes is a quality metric that is tracked and reported to providers in the perinatal episode model but is not directly tied to gain sharing. Executive Summary Perinatal Episode 2017, https://www.tn.gov/assets/entities/hcfa/attachments/PerinatalSummaryVC3.0.pdf

[160] TN: https://www.tn.gov/content/dam/tn/tenncare/documents2/PeriSumm2019V3.pdf

[161] TN: C-Section rate and primary C-section rate are quality metrics in the TennCare prenatal episode of care

[162] TN: PIP aims to improve access to prenatal and postpartum care.

[163] TN: https://www.tn.gov/content/dam/tn/tenncare/documents/AnnualEQROTechnicalReport.pdf

[164] TN: https://www.tn.gov/content/dam/tn/tenncare/documents/hedis18.pdf

[165] TN: https://tipqc.org/immediate-postpartum-long-acting-reversible-contraception/

[166] TN: TennCare has unbundled the payment of LARC devices from the global delivery fee https://www.acog.org/-/media/Departments/LARC/TN_PP-VRLAC-Public-Memo.pdf?dmc=1&ts=20190627T2306114718

[167] TN: TennCare has made it a priority for its MCO’s to perform outreach directly to women of child bearing age who may be using or misusing opioids. It is part of the larger TennCare opioid strategy, and all MCOs have increased their efforts for screening and care coordination. https://www.tn.gov/tenncare/tenncare-s-opioid-strategy.html

[168] TX: https://hhs.texas.gov/about-hhs/process-improvement/medicaid-chip-quality-efficiency-improvement/performance-improvement-projects

[169] TX: Postpartum depression (PPD) screening is covered under the mother’s and the infant’s identification number, with a maximum of one claim for PPD screening per identification number within 12 months of delivery.

[170] TX: Delivery (any method) prior to 39 weeks of gestation is not a benefit without documentation of medical necessity.

[171] https://hhs.texas.gov/sites/default/files/documents/about-hhs/process-improvement/quality-efficiency-improvement/Quality-Strategy-1115-Attachment-D-July-2017-Final.pdf

[172] TX: External Quality Review Organization Summary of Activities Report Contract Year 2015, https://hhs.texas.gov/sites/default/files//documents/about-hhs/process-improvement/quality-efficiency-inprovement/External-Quality-Review/Section-5-Quality-of-care-Evaluation-by-Program.pdf

[173] TX: https://hhs.texas.gov/about-hhs/process-improvement/medicaid-chip-quality-efficiency-improvement/pay-quality-p4q-program

[174] TX: Texas’ EQRO runs Office of Population Affairs contraceptive care measures for all Medicaid programs. https://www.hhs.gov/opa/performance-measures/index.html

[175] TX: https://thlcportal.com/measures/medical

[176] TX: Texas Medicaid coverage includes screening/treatment for sexually transmitted infections.

[177] TX: https://thlcportal.com/measures/medical

[178] TX: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a Texas Medicaid benefit during pregnancy and throughout the postpartum coverage period.

[179] TX: Group and individual smoking cessation counseling and treatments are a benefit of Texas Medicaid.

[180] UT:https://medicaid.utah.gov/Documents/pdfs/annual%20reports/external/EQR_report2018.pdf

[181] VT: https://dvha.vermont.gov/global-commitment-to-health/vt-gc-cqs-may-9-2018-update.pdf

[182] VA: Medallion 4.0 strategy focuses on women but does not outline specific measures https://www.dmas.virginia.gov/files/links/1566/Medallion%204.0%20Contract%20(07.26.2018).pdf

[183]  VA: Preventative and Restorative — https://www.dmas.virginia.gov/files/links/416/DMAS%2020172019%20Quality%20Strategy.pdf

[184] WA: https://www.hca.wa.gov/assets/program/washington-state-common-measures-2019.pdf

[185] WV: PIP aims to improve postpartum visits by increasing coordination with discharge nurse, MCO, and PCP.

[186] WV: PIP aims to improve early access to prenatal care.

[187] WV: West Virginia Mountain Health Trust Program State Strategy for Assessing and Improving Managed Care Quality Updated March 2015, https://www.dhhr.wv.gov/bms/CMS/SMP/Documents/SPAs/SPAs%202015/Managed%20Care%20SPA/Quality_Strategy.pdf

[188] WI: Resources for Hospital Providers, https://www.forwardhealth.wi.gov/WIPortal/content/Provider/medicaid/hospital/resources_01.htm.spage

[189] WI: Pay-for-performance Guides for Measurement Year 2019 https://www.forwardhealth.wi.gov/WIPortal/content/Provider/medicaid/hospital/resources_01.htm.spagepdf

[190] WI: Five health plans conducted PIPs on prenatal and postpartum care and used interventions such as provider education sessions and incentive programs for postpartum visits. Pay-for-Performance 2016 Guide, https://www.forwardhealth.wi.gov/WIPortal/content/Managed%20Care%20Organization/Quality_for_BCP_and_Medicaid_SSI/Home.htm.spage and External Quality Review FY 2015-2016 Annual Technical Report Badger Care Plus and Medicaid Supplemental Security Income Managed Care https://www.forwardhealth.wi.gov/WIPortal/content/Managed%20Care%20Organization/Quality_for_BCP_and_Medicaid_SSI/Home.htm.spage

[191] WI: Five health plans conducted PIPs on prenatal and postpartum care and did member outreach via phone calls, mailings and reminder postcards, and used interventions such as implementing a Pregnancy Rewards incentive program. Pay-for-Performance 2016 Guide, https://www.forwardhealth.wi.gov/WIPortal/content/Managed%20Care%20Organization/Quality_for_BCP_and_Medicaid_SSI/Home.htm.spage

[192] WI: Pay-for-performance Guides for Measurement Year 2019 https://www.forwardhealth.wi.gov/WIPortal/content/Provider/medicaid/hospital/resources_01.htm.spage

[193] WY: Medicaid health risk assessment called “Assess, Assist, Arrange!” screen for domestic violence. Positive responses are sent to the appropriate entity for follow up

[194] WY: Pediatric clinics participating in Medicaid PCMH are required to report Maternal Depression Screening measures monthly

[195] High Risk Maternity Program is able to assist with smoking cessation programs

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