Last updated: Aug. 30, 2022
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:
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:
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.
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:
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.