Managed Care Withholds and Incentives Initiative



The South Carolina Department of Health and Human Services (SCDHHS) in collaboration with our Coordinated Care Improvement Group has identified and targeted key withhold and incentive categories to assist us in measuring and supporting quality outcomes.

Quality delivery of health care becomes even more important as Medicaid consumes a greater portion of state general fund expenditures with more individuals enrolled in the health care program.  Implementation of pay-for-performance withholds and incentives program in the coordinated care delivery model allows for establishment of actuarially-sound capitation rates and validation of the delivery of managed health care services to support quality outcomes.  Withholds and Incentives are applicable to specified providers and Health Plans (MCOs and MHNs).

Attached is a brief summary of the categories included in this initiative.  Specific details can be found at by clicking on MCO Contract/P&P then click Policies and Procedures Guide-July 2012.  This information can be found in Appendix 5, page 117.

Please refer any questions or concerns regarding this bulletin to the Provider Service Center at 1-888-289-0709.  Thank you for your continued support of the South Carolina Medicaid program.

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