Performance measurement is a pillar of state Medicaid managed care quality improvement and oversight efforts, is often factored into plan payment, and supports public reporting.
In late 2022, NASHP scanned state Medicaid managed care programs to identify which behavioral health clinical and utilization performance measures they were using, as well as how they were using them in payment and public reporting. States can use this information to help expand and refine their own efforts to use behavioral health performance measures to ensure Medicaid beneficiaries access to high quality services.
Check out the map and chart below for an overview of our findings. You can also download the complete set of data (available as an Excel spreadsheet), or read one of our blogs:
Key Findings
According to data collected in 2022 from state contracts, quality strategies, and other resources posted to state websites:
- 43 Medicaid agencies (42 states and Washington DC) delivered behavioral health services to Medicaid beneficiaries through managed care organizations (MCOs) that delivered a comprehensive package of services, and/or prepaid inpatient health plans (PIHPs) and prepaid ambulatory health plans (PAHPs) that delivered only behavioral health services (MCOs, PIHPs, and PAHPs are collectively referred to as plans).
- 42 Medicaid agencies collected at least one measure of behavioral health performance.
- 29 factored performance on at least one behavioral health clinical or utilization measure into plan payment.
- Together, Medicaid agencies collected a total of over 100 different behavioral health performance measures, but only 15 were used in plan payment by more than one state.
States Collecting Behavioral Health Performance Measures: 2022
Explore the map and chart below for an overview of how states are collecting and using behavioral health (BH) measures in Medicaid managed care.
Download the Data
A complete set of the information collected through this scan is available for download as an Excel spreadsheet. This spreadsheet includes:
- All behavioral health measures states collect and use in payment
- A brief description of how each state ties payment to plan performance on behavioral health measures
- Links to state-produced public reports of individual plan performance
Sources
The data presented here were gathered primarily from review of the managed care contracts, quality strategies and annual external quality review reports produced by each state. In states with more than one Medicaid managed care program we reviewed the contracts for all programs. If a measure was collected or used by at least one of the programs, we included it in our data. In a few states we also used additional resources. These are listed below:
Arizona Health Care Cost Containment System Contractor Operations Manual
Chapter 300: Finance
306 – Alternative Payment Model Initiative – Withhold and Quality Measure Performance Incentive (CYE 20 Through CYE 22) https://www.azahcccs.gov/shared/Downloads/ACOM/PolicyFiles/300/306.pdf
Arizona Health Care Cost Containment System ACOM Policy 306, Attachment A -ALTCS Contractor Alternative Payment Model (APM)
Quality Management Performance Measure Standards
CYE 2020
https://www.azahcccs.gov/shared/Downloads/ACOM/PolicyFiles/300/306_A.xlsx
California Department of Health Care Services
Medi-Cal Managed Care Accountability Set (MCAS) for Managed Care Health Plans (MCPs)
Measurement Year 2022 | Reporting Year 2023
https://www.dhcs.ca.gov/Documents/MCQMD/MY2022-RY2023-MCAS.pdf
Colorado Department of Health Care Policy and Financing
Regional Accountable Entity Behavioral Health Incentive Specification Document: SFY 2021-2022
https://hcpf.colorado.gov/sites/hcpf/files/BH%20Incentive%20Program%20Specification%20Document%2021-22%20August%2031%2C%202021.pdf
Illinois Department of Healthcare and Family Services
Report Card Methodology 2022 (CY 2021)
https://www2.illinois.gov/hfs/SiteCollectionDocuments/IL2022CY2021CombinedReportCardMethodologyF2.pdf
Illinois Department of Healthcare and Family Services
2020 Statewide Scores & Ratings
https://www2.illinois.gov/hfs/healthchoice/reportcard/Pages/statewide_sc20.aspx
Indiana Family and Social Services Administration
Medicaid Policy, Quality and Outcomes Reporting
https://www.in.gov/fssa/ompp/quality-and-outcomes-reporting/
KanCare Dashboard 2016-2020
https://kancare.ks.gov/docs/default-source/policies-and-reports/quality-measurement/dashboard-2016-2020-(final).pdf?sfvrsn=3b4f511b_6
Kansas Department of Health and Environment Division of Health Care Finance
Fourth Quarter & Annual Report to CMS Regarding Operation of 1115 Waiver Demonstration Program Quarter Ending 12.31.2021 – Year Ending 12.31.2021
https://kancare.ks.gov/docs/default-source/policies-and-reports/annual-and-quarterly-reports/annual/kancare-quarterly-and-annual-report-to-cms—qe-12-31-21-revised.pdf?sfvrsn=95a501b_10
MassHealth 2021 Managed Care Plan Quality Performance
https://www.mass.gov/doc/managed-care-plan-quality-performance-2021-0/download
Bureau of Community Based Services
Behavioral and Physical Health and Aging Services Administration
Performance Bonus Incentive Program (PBIP) FY 2023
https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Keeping-Michigan-Healthy/BH-DD/Reporting-Requirements/PBI/Performance_Bonus_Incentive_Pool_FY23.pdf?rev=e587b542100e4256ba85fa203c0b454f&hash=82EBDF3B193A09A0FEFA789EE03A88B1
Michigan Department of Health and Human Services
2021 HEDIS Aggregate Report for Michigan Medicaid
https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Folder50/Folder12/MI2021_HEDIS_MHP_Aggregate_Report_F1_rev.pdf?rev=514edf0c35a74850beba24be908f8466&hash=ABB9914438BC609EA150C5514C0A9C6A
State of Michigan Contract No.
Comprehensive Health Care Program for the Michigan Department of Health and Human Services
https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Folder1/Folder101/contract_7696_7.pdf?rev=6b613a9a8ae04ede8b764176b3b9ab7e)
Mississippi Division of Medicaid
Measuring Managed Care Performance
(https://medicaid.ms.gov/programs/managed-care/measuring-managed-care-performance/)
Mississippi Division of Medicaid
MississippiCAN Resources
(https://medicaid.ms.gov/mississippican-resources/)
National Committee for Quality Assurance
Health Plans, Nevada
https://reportcards.ncqa.org/health-plans?dropdown-state=Nevada&filter-state=Nevada&filter-plan=Medicaid&pg=1https://dhcfp.nv.gov/ManagedCareContracts/
New Hampshire Department of Health and Human Services (DHHS) Medicaid Care Management Program
Guidance for Medicaid Care Management (MCM) Withhold and Incentive Program Services in the MCM Contract
https://www.dhhs.nh.gov/sites/g/files/ehbemt476/files/documents/2021-11/19-0028-r5-mcm-withhold-and-incentive-guidance-20210511.pdf
Department of Health and Human Services, Division of Medicaid Services
Request to authorize amendments to managed care contracts
https://sos.nh.gov/media/gzgppfzr/020a-gc-agenda-06012022.pdf
Member Enrollment Guide to the Quality of New Hampshire Medicaid Health Plans
https://medicaidquality.nh.gov/sites/default/files/DMS%201070%202021-07%20MCM%20Member%20Enrollment%20Quality%20Report.pdf
New York Managed Care Plan Utilization Data
https://health.data.ny.gov/api/views/h8yk-ufg9/files/6d6666b5-462b-4de6-827f-c5ddf15d6a68?download=true&filename=NYSDOH_Util_measures_2020-2021.pdf
New York State Department of Health Managed Care Plan Reports
https://www.health.ny.gov/health_care/managed_care/reports/
Oregon CCO Measures Matrix
https://www.oregon.gov/oha/HPA/ANALYTICS/CCOMetrics/CCO-All-Measures-Matrix.pdf
Oregon Health System Transformation CCO Metrics 2021 Final Report
https://www.oregon.gov/oha/HPA/ANALYTICS/CCOMetrics/2021_CCO_metrics_report.pdf
Managed Care Operations Memorandum General Operations MCOPS Memo # 09/2022-007
https://www.dhs.pa.gov/HealthChoices/HC-Services/Documents/Managed%20Care%20Operations%20Memos/MCS-09-2022-007.pdf
South Carolina Healthy Connections Medicaid Policy and Procedure Guide for Managed Care Organizations, 2021
https://msp.scdhhs.gov/managedcare/sites/default/files/Final%20MCO%20PP%20July%202022%20-%20update.pdf
Department of Vermont Health Access Medicaid Performance Measures
https://dvha.vermont.gov/quality/medicaid-performance-measures
Virginia Medicaid Managed Care Behavioral Health HEDIS Data 2020
https://www.dmas.virginia.gov/media/3666/virginia-medicaid-managed-care-behavioral-health-hedis-2020.pdf
Commonwealth of Virginia Department of Medical Assistance Services
SFY 2023 Performance Withhold Program Methodology
https://www.dmas.virginia.gov/media/4807/va-eqro-sfy-2023-pwp-methodology-f2.pdf
Commonwealth of Virginia Department of Medical Assistance Services
SFY 2022 CCC Plus Performance Withhold Program Methodology
https://www.dmas.virginia.gov/media/3053/ccc-plus-sfy-2022-pwp-methodology.pdf
Mountain Health Promise: Reporting Required by W. Va. Code §9-5-27, July 2022
https://dhhr.wv.gov/bms/Members/Managed%20Care/MHP/Documents/MHP_Legislative%20Report%20%C2%A79-5-27_%20FINAL%20%281%29.pdf
Badgercare Quality Guide
https://www.forwardhealth.wi.gov/WIPortal/Subsystem/ManagedCare/HMOAdministrators.aspx
Acknowledgements
The National Academy for State Health Policy (NASHP) would like to thank Health Resources and Services Administration Project Officer Kelli Crosby and her colleagues for their feedback and guidance. This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under co-operative agreement number UD3OA22891, National Organizations of State and Local Officials. The information, content, and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. government.
