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20-288 Stay Current with MCAS Updates to Be Sure You Meet Performance Levels

Date: 03/23/20

Latest changes released for 2020 measurement year

On September 16, 2019, California Health & Wellness Plan (CHWP) notified providers about new quality measures known as the Managed Care Accountability Set (MCAS), released by the Department of Health Care Services (DHCS). You can refer to provider update 19-676, Help Your Patients Achieve Better Health Outcomes for more details. DHCS now requires managed care plans and participating providers to meet the national Medicaid 50th percentile minimum performance level (MPL) for each MCAS measure based on the National Committee for Quality Assurance (NCQA) Quality Compass.

New changes for 2020 measurement year

On December 31, 2019, DHCS updated the MCAS list for the 2020 measurement year. New changes to MCAS are outlined in the table on page 2. Providers and plans must still meet the MCAS Measurement Year (MY) 2019/Reporting Year (RY) 2020 requirements as outlined in provider update 19-676.

Timely submissions of claims, encounters and medical records impact your performance rates

We encourage providers to stay up to date with the coding guidelines as outlined in the most recent release of the HEDIS 2020 Volume 2: Technical Specifications. You can purchase the guidelines from the NCQA website at www.ncqa.org.

For more information on coding and best practices, providers can access the Healthcare Effectiveness Data and Information Set (HEDIS®) tip sheets and best practices at www.CAHealthWellness.com under For Providers > Quality Improvement (QI) Program > Provider Tip Sheets. Providers can also email the Practice Transformation Team at HEDIS_help@cahealthwellness.com.

Resources for claims and encounters requirements

Independent practice associations (IPAs) and providers are required to report services according to the terms of the Provider Participation Agreement (PPA). Providers can also refer to the CHWP Provider Operations Manual for more information on billing and reporting requirements available on at www.CAHealthWellness.com under For Providers > Provider Resources > Manuals, Forms and Resources > Manuals > Billing and Submission.

Additional information

Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 1-877-658-0305.

Highlights of the 2020 measurement year changes

The complete MCAS list is available online at: www.dhcs.ca.gov/dataandstats/reports/Documents/MMCD_Qual_Rpts/HEDIS_Reports/Managed-Care-Accountability-Set-Reporting-Year-2021.pdf.

Removed

Added

Changed

Adult Care

  • Annual Monitoring for Patients on Persistent Medications (MPM)
  • Comprehensive Diabetes Care Hemoglobin A1c testing (CDC-HT)
    -    HbA1c testing with outcomes > 9.0% (CDC-H9) is still required

 

Behavioral Health (pediatric and adult)

  • Addition of Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-CH)
  • Addition of Diabetes Screening for People with Schizophrenia or Bipolar Disease Using Antipsychotic Medications (SSD-AD)

Transitional Care

Plan All‐Cause Readmissions (PCR)

  • No longer held to the MPL for RY 2021

Pediatric Care

Children and Adolescent Access to Primary Care Practitioners (CAP)

Pediatric Care

  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents: counseling for nutrition (WCC-N), ICD-10 Z71.3
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents: counseling for physical activity (WCC-PA), ICD-10 Z02.5, Z71.82