February 01, 2022

Michigan: Updates to the 2022 Care Management and Quality Incentive Program for UnitedHealthcare Community Plan Primary Care Physicians (PCPs)

For certain contracted Michigan UnitedHealthcare Community Plan Medicaid PCPs.

Effective Jan. 1, 2022, we have updated the 2022 Care Management and Quality Incentive Program for Michigan. These updates are for certain contracted Medicaid PCPs. The program was designed with the goal of helping your patients who are UnitedHealthcare Community Plan members become more engaged with their preventive health care.

For general program information, please contact Provider Services at 877-842-3210.

What’s new for 2022?

Updates for 2022 in Michigan include:

  • Care coordination fees will be paid to providers who have current Patient-Centered Medical Home (PCMH) certification status. As with the 2021 program, there is no annual maximum limit for the care coordination fee payments.
  • Increased incentive payment for care management codes submission for primary care providers (PCPs) from $10 to $50
  • Providers can earn additional new incentives for submitting ICD-10 Z codes based on the results of social determinants of health assessments

This information is also included in a fax alert recently sent to impacted practices.

Earning your incentive – care coordination fee
Monthly care coordination fee payments are available to PCPs with current Patient-Centered Medical Home accreditation/certification status who meet specific criteria.

The following table outlines the requirements to receive care coordination fees in 2022:

 

  Tier 1 Tier 2

Panel status

Open

Closed

Membership threshold

50+ members

500+ members

PCMH certification

Yes

Yes

Monthly PMPM

$1.25 PMPM

$1.25 PMPM

Please Note: Care coordination fees are recalculated in January and July and exclude Children’s Special Health Care Services (CSHCS) and Medicaid secondary members.

The following PCMH certification will be accepted:

  • National Committee for Quality Assurance (NCQA®)
  • Blue Cross Blue Shield of Michigan Primary Group Incentive Program (PGIP)
  • Utilization Review Accreditation Commission (URA)
  • Accreditation Association for Ambulatory Health Care (AAAHC) Medical Home
  • The Joint Commission® Primary Medical Home
  • Commission on Accreditation of Rehabilitation Facilities – Health Home (CARF)
  • Other MDHHS approved certifications

Earning your incentive — quality bonus
Participants in the 2022 Care Management and Quality Incentive Program can earn a bonus for addressing care opportunities tied to specific quality measures.

View the full details, including bonus incentive values and diagnosis and CPT® codes in the list below. 

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Combo 10 Completion: $100 for complete series
Criteria: Must be completed on or before 2nd birthday and consist of the following: 4 DTaP, 3 IPV, 1 MMR, 3 HiB, 3 Hepatitis B, 1 VZV, 4 PCV, 1 Hepatitis A, 2 or 3 RV (2 or 3 dose schedule), 2 Influenza

Administration fee is paid in addition to incentive on FFS basis via claim payment.

Lead Screening Completion: $25
Criteria: Member must have at least 1 capillary or venous lead screening on or before 2nd birthday.

CPT code: 83655

Appropriate Testing for Pharyngitis: $10
Criteria: Members between the ages of 3-65+ who are diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode.

Diagnosis codes: J02.0; J02.8; J02.9; J03.00–01; J03.80–81; J03.90–91
Group A Strep Tests: 87070–87071; 87081; 84730; 87650–87652; 87880
Antibiotics: Amoxicillin; Amoxicillin-clavulanate; Ampicillin; Azithromycin; Cefaclor; Cefadroxil; Cefazolin; Cefdinir; Cefditoren; Cefixime; Cefpodoxime; Cefprozil; Ceftibuten; Ceftriaxone; Cefuroxime; Cephalexin; Ciprofloxacin; Clarithromycin; Clindamycin; Dicloxacillin; Doxycycline; Erythromycin; Erythromycin ethylsuccinate; Erythromycin lactobionate; Erythromycin stearate; Levofloxacin; Minocycline; Moxifloxacin; Ofloxacin; Penicillin G benzathine; Penicillin G potassium; Penicillin G sodium; Penicillin V potassium; Sulfamethoxazole-trimethoprim; Tetracycline; Trimethoprim

Cervical Cancer Screening: $20
Criteria: Women between the ages of 21–64 who are screened for cervical cancer

CPT code: 88141–88143; 88147–88148; 88150; 88152–88154; 88164–88167; 88174–88175; 87620–87622; 87624–87625; G0123–G0124; G0141; G0143–G0145; G0147–G0148; G0476; P3000; P3001; Q0091

Breast Cancer Screening: $20
Criteria: Women between the ages of 50–74 who had a mammogram to screen for breast cancer
CPT code: 77055–77057; 77061–77063; 77065–77067; G0202; G0204; G0206

Chlamydia Screening: $20
Criteria: Women between the ages of 16–24 who had a chlamydia screening (urine or culture)
CPT code: 87110; 87270; 87320; 87490–87492; 87810

Prenatal Care: $20
Criteria: Multiple qualifying CPT codes as defined by HEDIS® specifications

Postnatal Care: $20
Criteria: Multiple qualifying CPT codes as defined by HEDIS® specifications

Tobacco Cessation Counseling: $5
Criteria: Members, ages 14 and older, in which had a smoking and tobacco use cessation visit
CPT code: 99406; 99407

Members must have at least 2 face-to-face (i.e., E&M) claims in a 2-year period with a diagnosis of diabetes

HbA1c Control (<8.0%): $15
Criteria: Members between the ages of 18–75 whose most recent HbA1c level is <8.0%
CPT codes: 83036; 83037
CPT Category II: 3044F; 3051F

Completion of Diabetic Eye Exam: $15
Criteria: Members between the ages of 18–75 who have been screened or being monitored for diabetic retinal disease

Services include: A retinal or dilated eye exam by an eye care professional (optometrist or ophthalmologist) in the measurement year or a retinal or dilated eye exam that is negative for retinopathy by an eye care professional within the past 2 years; Bilateral eye enucleation any time during the member’s history through Dec. 31

CPT Category II: 2022F–2026F; 2033F

Kidney Evaluation for Diabetes: $15
Criteria: Members between the ages of 18–85 who must have both the serum eGFR (estimated glomerular filtration rate) and a urine ACR (albumin creatinine ratio) lab tests

CPT codes: 80047; 80048; 80050; 80053; 80069; 82565; 82570; 82042–82044; 84156
CPT Category II: 3060F; 3061F; 3062F

Antipsychotic Medication Adherence: $25
Criteria: Members, 18 years and older, who were dispensed and remained on an antipsychotic medication for at least 80% of their treatment period

Asthma Medication Ratio: $25
Criteria: Members between the ages of 5–64 who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications

Well-Child Visits in the First 30 Months of Life: $75
Criteria: Children who turned 15 months old must have 6 or more well-child visits. Children who turned 30 months old must have 2 or more well-child visits.

Diagnosis codes: Z00.110; Z00.111; Z00.121; Z00.129
CPT codes: 99381–99382; 99391–99392

Child and Adolescent Well-Care Visits: $15
Criteria: Members between the ages of 3–21 who had at least 1 comprehensive well-care visit with their PCP
Diagnosis codes: Z00.121; Z00.129

CPT codes: 99382–99385; 99392–99395

Completion of Healthy Michigan Health Risk Assessment: $25

$25 received by fax
$50 entered into CHAMPS

Criteria: One per member per measurement year; members must maintain or select a healthy behavior

$50 for each of these CM/CC codes that does not have a state assigned Medicaid rate:

  • G9001 Comprehensive Assessment
  • G9002 In-Person Care Management/Care Coordination Encounter
  • G9007 Care Team Conferences
  • G9008 Provider Oversight
  • 98966 Telephone Care Management/Care Coordination Services
  • 98967 Telephone Care Management/Care Coordination Services
  • 98968 Telephone Care Management/Care Coordination Services
  • 98961 Education/Training for Patient Self-Management
  • 98962 Education/Training for Patient Self-Management
  • S0257 End of Life Counseling

PCPs have a new opportunity to earn incentives for the submission of Social Determinant of Health (SdoH) ICD-10 Z codes (Z55-Z65 and Z75) based on the results of SdoH assessments. Providers who submit SdoH-related Z codes for 5% of their seen members will earn a $0.50 PMPM payment while providers who submit these codes for 10% of their seen members will earn a $1.00 PMPM payment. Membership for the PMPM payment will be based on the provider’s entire assigned membership for the year. Z code incentives will be paid annually at the time of quality incentive payments.

PCA#-1-21-04472-C&S-News