Quality Weighted Assignments

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The South Carolina Department of Health and Human Services (SCDHHS) will be implementing a Quality Weighted Assignment algorithm for enrollments that begin on or after January 1, 2013. Beneficiaries who are managed-care-assignable, but have not selected a health plan, will be assigned to a health plan by the enrollment broker based on this algorithm.

 

SCDHHS has committed to providing statewide leadership to most effectively utilize resources to promote the health and well-being of South Carolinians.  The State intends to promote and further its mission by defining measurable results that will improve Medicaid Managed Care Organization Member access and satisfaction, maximize program efficiency, effectiveness and responsiveness, and reduce operational and service costs.

 

The Quality Weighted Assignment algorithm is linked to a health plan’s overall score on the Health Plan Report Card. The first assignments utilizing quality will occur based on the scores from calendar year 2011 and released in November 2012. The Report Card will be updated twice annually, in July and January.

Specifics of the quality weighted assignments algorithm can be found at https://msp.scdhhs.gov/managedcare by clicking on MCO Contract/P&P then click Policies and Procedures Guide-July 2012.  This information can be found in Appendix 6, page 123.

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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