Medicare-Medicaid Plan (MMP) Quality Withhold Methodology & Technical Notes
Guidance for information on Medicare-Medicaid Plan (MMP) Quality Withhold Methodology & Technical Notes.
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 11, 2020
| 02/05/2024: CMS released the revised Capitated Financial Alignment QW Methodology for Massachusetts, Michigan, Ohio, Rhode Island, & South Carolina for Demonstration Years 2-12 (accordingly). More information is available below. |
| 01/11/2024: CMS released the revised Capitated Financial Alignment QW Methodology for Illinois, Texas, & New York (FIDA-IDD) for Demonstration Years 2-11 (accordingly). 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:
- Capitated Financial Alignment Demonstration Year 1 QW Methodology & CMS Core Technical Notes (06/06/2014) (PDF)
- Capitated Financial Alignment Demonstration Years 2 - 12 QW Methodology & CMS Core Technical Notes (10/19/2023) (PDF)
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:
- Quality Withhold Adjustment for Extreme and Uncontrollable Circumstances (04/01/2019) (PDF)
- Quality Withhold Impacts due to the COVID-19 Public Health Emergency (07/29/2020) (PDF)
- CY 2021 Quality Withhold Analysis Update Memorandum (11/17/2021) (PDF)
California
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for California (PDF)
- Capitated Financial Alignment Demonstration Years 2-8 QW Methodology for California (PDF)
Illinois
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for Illinois (PDF)
- Capitated Financial Alignment Demonstration Years 2-11 QW Methodology for Illinois (PDF)
Massachusetts
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for Massachusetts (PDF)
- Capitated Financial Alignment Demonstration Years 2-12 QW Methodology for Massachusetts (PDF)
Michigan
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for Michigan (PDF)
- Capitated Financial Alignment Demonstration Years 2-10 QW Methodology for Michigan (PDF)
New York - Fully Integrated Duals Advantage (FIDA)
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for New York - FIDA (PDF)
- Capitated Financial Alignment Demonstration Years 2-5 QW Methodology for New York - FIDA (PDF)
New York - FIDA Intellectual and Development Disabilities (FIDA-IDD)
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for New York - FIDA-IDD (PDF)
- Capitated Financial Alignment Demonstration Years 2-8 QW Methodology for New York - FIDA-IDD (PDF)
Ohio
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for Ohio (PDF)
- Capitated Financial Alignment Demonstration Years 2-11 QW Methodology for Ohio (PDF)
Rhode Island
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for Rhode Island (PDF)
- Capitated Financial Alignment Demonstration Years 2-9 QW Methodology for Rhode Island (PDF)
South Carolina
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for South Carolina (PDF)
- Capitated Financial Alignment Demonstration Years 2-10 QW Methodology for South Carolina (PDF)
Texas
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for Texas (PDF)
- Capitated Financial Alignment Demonstration Years 2-10 QW Methodology for Texas (PDF)
Virginia
(demonstration ended 12/31/2017)
- Capitated Financial Alignment Demonstration Year 1 QW Methodology for Virginia (PDF)
- Capitated Financial Alignment Demonstration Years 2 & 3 QW Methodology for Virginia (PDF)
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