Medicare-Medicaid plans (MMPs) report monitoring and performance measures consistent with the three-way contracts with states, the Medicare-Medicaid capitated financial alignment model core reporting requirements, and state-specific reporting requirements.
For the 2023 performance measure validation (PMV) cycle (covering data reported for the 2022 measurement year), CMS will select a subset of MMPs to undergo validation to ensure the MMPs’ reported data are reliable, valid, complete and comparable.
The selection will be based on performance in prior PMV cycles, concerns regarding data accuracy, and/or a random sample. The following core measures will be validated:
- Members with an assessment completed within 90 days of enrollment (Core 2.1)
- Members with a care plan completed within 90 days of enrollment (Core 3.2)
Similar to previous cycles, the PMV review of the selected MMPs’ reported data will consist of pre-validation, remote validation, and post-validation activities focusing on enrollment and eligibility data processes, assessment and care plan completion processes, performance measure production, and primary source verification.
CMS expects that pre-validation activities will commence in June, 2023, with remote validation (e.g., virtual reviews) occurring in August and September, 2023. Final PMV reports will be available in December, 2023.
As with the prior PMV cycle, selected MMPs will be limited to no more than two virtual reviews during the review period. It’s important to note that selected MMPs that receive a finding of “Do Not Report” in their final PMV report for Core 2.1 and/or Core 3.2 may be subject to compliance action from CMS.
CMS contractors NORC at the University of Chicago and Health Services Advisory Group, Inc. will be in touch with MMPs to provide more information about next steps, including informing each MMP regarding its selection status.
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