Michigan: Updates to the 2022 Care Management and Quality Incentive Program for UnitedHealthcare Community Plan Primary Care Physicians (PCPs)
Last updated: Aug. 30, 2022
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 visit our Contact Us page.
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:
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)
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.
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.
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
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.
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.