CSAC Bulletin Article

DHCS Publishes Quality Ratings on Medi-Cal Managed Care Plans and County Behavioral Health Plans

February 15, 2024

This week, the Department of Health Care Services (DHCS) published quality ratings and imposed monetary sanctions on Medi-Cal managed care plans (MCPs) that do not meet required performance levels. The new MCP model contract took effect on January 1, 2024, and seeks to strengthen quality and health equity requirements for MCPs.

Additionally, for the first time, DHCS released quality ratings for county behavioral health plans, based upon performance.  This is the first year DHCS is releasing quality scores for county behavioral health plans, but there are no sanctions being issued to these plans.

DHCS is issuing quality measure ratings for Measurement Year (MY) 2022 for all MCPs and county behavioral health plans to help drive improvement in support of greater plan engagement and outreach to ensure the medical needs of Medi-Cal members are prioritized, especially preventive care and primary care services that promote health and well-being.

Eighteen of the 25 MCPs will be fined due to performance rates below designated Minimum Performance Levels (MPLs). For MY 2022, MCP sanctions ranged from $25,000 to $890,000 based upon factors that include the eligible population impacted, the degree to which a plan fell below MPLs, the degree of improvement or decline from the previous MY, and the plan’s Healthy Places Index (HPI) score for assigned membership to that plan.

For county behavioral health plans, counties overall performed well on mental health quality measures, with 71% of counties meeting MPLs on at least half of the mental health measures related to follow up after emergency department visits and hospitalizations related to mental illness, and management of antidepressant medications. County performance was similar on substance use disorder (SUD) measures, with 80% of counties meeting MPLs for at least half of the measures related to follow up after emergency department visits for SUD, use of pharmacotherapy for opioid use disorder, and initiation and engagement with SUD treatment.

Under their contract with DHCS, all plans (both MCPs and county behavioral health plans) are required to meet the DHCS established MPLs for each Medi-Cal Managed Care Accountability Set (MCAS) performance measure.

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