Central California Alliance For Health


What's New for CBI 2020

2020 Department of Health Care Services (DHCS) Program Update

The Department of Health Care Services (DHCS) notified the Alliance of the new Quality Measures that are required to be reported in 2020. The new measures align with the Centers for Medicare & Medicaid Services (CMS) Adult and Child Core Measure Sets. As a result, the Alliance has modified the 2020 CBI Program to incorporate some of the CMS measures.

Clarification has also been provided by the DHCS All Plan Letter 19-005 for Pay-For-Performance (P4P), to Federally Qualified Health Centers (FQHC) and Rural Health Clinics. The Alliance may not utilize financial incentives to pay an additional rate per service or visit based on utilization. As a result, changes have been made to the FFS measures for CBI 2020.

New Programmatic Measures

Care Coordination: Access Measures

Developmental Screening in the First Three Years: Members screened for risk of developmental, behavioral, and social delays using a standardized tool in the 12 months preceding or on their first, second or third birthday.

Quality of Care Measures

Antidepressant Medication Management: Members 18 years or older who were treated with antidepressant medication, had a diagnosis of major depression, and remained on antidepressant medication for at least 84 days (12 weeks).
BMI Assessment: Adult: Members 18 – 74 years of age who had a visit with their PCP and whose BMI was documented on the claim.
BMI Assessment: Children & Adolescents: Members 3 – 17 years of age who had a visit with their PCP and whose BMI percentile was documented on the claim.
Well-Child Visits First 15 Months of Life: Members turning 15 months during the measurement year and had 6 or more well-child visits with a PCP.
Maternity Care: Prenatal: This measure was previously a fee-for-service measure. This measure looks at claims and has continuous enrollment criteria of 43 days prior to delivery through 60 days after delivery.

Measure Changes

Cervical Cancer Screening: Now includes women 30–64 years of age who had cervical high-risk human papillomavirus testing performed every 5 years.
Hba1C Good Control <8.0% has changed to Hba1C Poor Control >9.0%, and looks at members 18-75 with diabetes (type 1 and type 2) with an HbA1c score >9.0%. This is a reverse measure; lower number is a better score.
Immunizations: Children (Combo 3) has changed to Combo 10 to include additional vaccines (2 or 3 Rotavirus, 1 Hep A, and 2 Influenza).
Maternity Care: Postpartum: Measure specifications changed; payment is based on members who receive a postpartum visit with a PCP within 7 and 84 days after delivery.

Fee-For-Service Measures

New Measure:

Behavioral Health Integration: Payment is based on CBI sites that achieve a NCQA Distinction in Behavioral Health. Providers with Joint Commission (TJC) Patient Certified Medical Home (PCMH) certification will also receive payment as it is included in the certification.

Measure Changes:

Patient Centered Medical Home (PCMH): NCQA levels were removed. Payment is based on NCQA accreditation or The Joint Commission PCMH recognition.

New Exploratory Measures (Formerly Provisionary)

These measures will not qualify for payment in 2020. They are being considered to be added as a paid measure in the 2021 CBI Program.

90-Day Referral Completion: Members who complete their initial referral from a PCP to a specialist within 90 days
Application of Dental Fluoride Varnish: Members age 6 month - 5 years of age (up to before their 6th birthday) who received at least one topical fluoride application by staff at the PCP office within the CBI reporting year
Breast Cancer Screening: Female members 50 – 74 years of age who had a mammogram on or between October 1, two years prior to the measurement period and the end of the Measurement Period
Chlamydia Screening in Women: Female members 16 - 24 years of age who were identified as sexually active and received at least one test for chlamydia in the last 12 months
Controlling High Blood Pressure: Members 18 – 85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140 />90 mm Hg) in the last 12 months
Immunizations: Adults: Members 19 years of age or older should receive all of the following vaccines:
Tetanus, diphtheria toxoids and acellular pertussis (Tdap)
Members 50 years of age or older: Zoster
Member Satisfaction: Provider’s member satisfaction scores for:
1. Getting Timely Appointments, Care, and Information
2. How Well Providers Communicate with Patients

Retired Measures

Depression Screening and Follow-up
Diabetic Retinal Exam
Healthy Weight for Life (Form is being retired. Data will be captured through BMI Assessment measure)
Maternity Care: Prenatal Care FFS Measure
Formulary Adherence
Formulary Medication Utilization: AirDuo & Basaglar


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