The Illinois Department of Healthcare and Family Services (HFS) is announcing its Illinois Health Connect (IHC) Bonus Payment program for Calendar Year (CY) 2016. Under this program, participating Illinois Health Connect Primary Care Providers (PCPs) continue to be eligible to receive annual bonus payments for care coordination efforts that result in qualifying services under a bonus measurement.
- Immunization Combo 3: Children who receive designated immunizations by 24-months of age.
- Developmental Screening: Children who receive at least one objective screening on or before their 1st birthday (12 months of age), children with one developmental screening after their 1st birthday (12 months of age) and on or before their 2nd birthday (24 months of age), children with one developmental screening after their 2nd birthday (24 months of age) and on or before their 3rd birthday (36 months of age).
- Medication Management for People with Asthma: Patients with persistent asthma ages 5-11 years, ages 12-18 years, ages 19-50 years, and ages 51-64 years who fill at least one asthma controller medication prescription that covers at least a 75% portion of days during the measurement period. A bonus will be available for each separate age group.
- Diabetes Management: Patients with diabetes ages 18 to 75 years who receive at least one HbA1c test.
- Breast Cancer Screening: Women between ages 50 and 74 who have had a mammogram in the last two years.
- Lead Screening: Children who receive at least one capillary or venous blood lead test by the age of 24 months.
The six bonus measurements were previously selected by the Department of Healthcare and Family Services (HFS) based on input from participating PCPs, clinicians and health care quality specialists who participated in the Provider & Quality Management Subcommittee. The HEDIS asthma management measure previously used for persistent asthma was retired by HEDIS; it is replaced with a similar HEDIS measure that also reviews the use of controller medications for persons with persistent asthma.
A qualifying PCP is an Illinois Health Connect PCP who meets or exceeds the 2016 HEDIS benchmarks collectively for all the Illinois Health Connect enrollees on their panel roster for each particular measure, or in the case of development screening, the benchmark target set forth by HFS.
HEDIS is the Healthcare Effectiveness Data and Information Set, which is a national reporting system administered by the National Committee for Quality Assurance (NCQA) to measure performance on a number of important measures of care and service. Most commercial health plans and state Medicaid programs utilize these measures. National benchmarks are reported annually which provide a summary of the various metrics.
HEDIS benchmark percentages and values are proprietary information of the National Committee for Quality Assurance (NCQA) and cannot be provided due to copyright laws.
HFS will count the number of qualifying patients for each measure enrolled on each PCP’s Illinois Health Connect panel roster on December 1, 2016. HFS will then look to see which of those patients received the measure’s qualifying service during the measurement period.
HFS claims data will be used to determine whether a service was rendered (for immunizations, ICARE and Cornerstone data will also be used, and for the lead measure, data from IDPH will also be used). Although providers now have six (6) months from the date of service to bill HFS in order to be paid for the service, the CY2016 bonus payment will be based on CY2016 claims received no later than the end of a three month run out (through March 2017), meaning all claims for these services must be submitted to HFS prior to April 1, 2017 to be counted in the bonus measurement calculations for CY2016.
PCPs do not have to report any special information to earn a bonus payment; they just need to submit the usual detailed claims for the services that are rendered during CY2016 (Jan 1-Dec 31, 2016). All of the claims for the bonus measure services are counted. HFS will count the number of qualifying patients for each measure and see which of those patients received the services during the measurement period. Regardless of whether services occurred with the current PCP or another provider during CY2016; it is whomever the patient is enrolled with on December 1, 2016 (on that PCP’s Illinois Health Connect panel roster) that determines which qualifying PCP is awarded the bonus payment for that qualifying patient service.
If a PCP meets or exceeds the benchmark for a particular measured service, a bonus payment will be made for each patient that received the measured services. If a PCP does not meet the benchmark for a bonus measurement there will be no bonus payment made for any patients in that measure even if the patients received the service.
Please note that the IHC Bonus Program for (Calendar Year) CY2016 will have
bonus payments of $35 per qualifying service when the seventy-fifth percentile of the national HEDIS benchmark for the measured service (or the Illinois benchmark for the Developmental Screening measure) is met or exceeded.
More specific information about each bonus measurement and the target benchmarks can be found on the Illinois Health Connect website at www.illinoishealthconnect.com under the Quality Tools section or obtained by calling the Illinois Health Connect Provider Helpdesk at 1-877-912-1999 option #3.
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