HEDIS Measures Incentive Program. In order to encourage consistent improvements in health outcomes, the Department shall create a HEDIS Measure Incentive Program (“Incentive Program”) as follows: A. The Department created a HEDIS Measure Incentive Program Pool (the “Pool”) of one percent (1%) of the Capitation Payments (excluding Duals or health insurer’s assessments) for the period July 1, 2015 through December 31, 2015. B. Starting with calendar year 2016, the Incentive Program shall operate in twelve-month calendar year periods, otherwise known as the Incentive Period, and the Pool will be 1.25% of the Capitation Payments (excluding Duals, or health insurer’s assessments). C. Incentives are a HEDIS Measure Performance Incentive (a “Performance Incentive”) and a HEDIS Measure Improvement Incentive (an “Improvement Incentive”). The Department shall allocate a part of the Pool into the Performance Incentive and the Improvement Incentive. The Contractor shall be eligible to participate in the Performance Incentive provided it has HEDIS Measurements in the Calendar Year of the Incentive Period. The Contractor is eligible to participate in the Improvement Incentive provided it has HEDIS Measurements in both the Calendar Year of the Incentive Period and in the preceding year. D. The Pool shall be distributed based upon the Contractor’s earned Shares. Shares are determined for each HEDIS Measurement, including behavioral health HEDIS measures, provided all MCOs within the Incentive have a measurement (common measure). E. The Performance Incentive shares are determined using the most current National Medicaid Benchmarks Percentiles when possible. The Contractor will receive one-quarter (0.25) share for each HEDIS Measurement that is greater than or equal to the fifty percentile and less than the seventy-five percentile (>= 50% and <75%) in the HEDIS Measurement Year/Incentive Period. The MCO will receive one-half (0.5) share for each HEDIS Measurement that is greater than or equal to the seventy-five percentile and less than the ninety percentile (>= 75% and <90%) in the HEDIS Measurement Year/Incentive Period. The MCO will receive one (1.0) share for each HEDIS Measurement that is greater than or equal to the ninety percentile (>=90%) in the HEDIS Measurement Year/Incentive Period. F. The Improvement Incentive shares are determined using MCO HEDIS Measurements from the Incentive Period and the preceding year. The MCO will receive one (1.0) share for each two percentage (2%) increase in a HEDIS Measurement between the Incentive Period and preceding year. G. The MCO Total Incentive Payment is the sum of the MCO Performance Incentive and the MCO Improvement Incentive. The MCO Incentive amounts are determined as the Total Incentive Pool multiplied by the product of the Incentive amount based on the MCO’s premiums and MCO’s Incentive Shares) divided by (the sum of the product for each participating MCO’s Incentive amount based on the MCOs premiums and MCO’s Incentive Shares). Steps followed to determine the Incentive Payments can be found in Appendix G. “HEDIS Measures Incentive Program.”
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Samples: Medicaid Managed Care Contract, Medicaid Managed Care Contract, Medicaid Managed Care Contract
