Regulatory Updates

Fidelis Care's new Quality Care Incentives (QCI) program rewards groups/practices for providing recommended preventive care, for caring for members with chronic disease, and for comprehensive obstetrical care. 

As in 2018, there will be one performance threshold for all Medicaid measures. It will be based on 2018 QARR data (usually reported by the SDOH in November 2019) and it will be set at the 85th percentile of New York Medicaid Plans that perform statistically at or above the Statewide average. 

Eligibility for the annual component of the Quality Care Incentives will continue to include practices that have between 150-249 Fidelis Care members as of December 2019. For practices with 200-249 members, the incentive for each measure will be 75% of the amount listed in the brochure, and for practices with 150-199 members, the incentive for each measure will be 50% of the listed amount. 

Providers who are contracted with Fidelis Care for Medicare Advantage and Dual Advantage products are eligible to receive Quality Care Incentives for Medicare and Dual members. Thresholds for Medicare members are based on performance of all Medicare Advantage programs that report HEDIS data to CMS, and are set at two percentage points above the 75th percentile. Please see Table B for more information. 

Members of the Health and Recovery Plan (HARP) and the Essential Plan are also eligible for Quality Care Incentives in 2019.

Full text of brochure with tables is available on Provider Access Online
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