Back to Directed Payments

Beginning with the State Fiscal Year (SFY) 2017-18 rating period, the Department will implement a managed care Designated Public Hospital (DPH) Quality Incentive Pool (QIP). The Department will direct Managed Care Plans (MCPs) to make QIP payments tied to performance on designated performance metrics in four strategic categories: primary care, specialty care, inpatient care, and resource utilization. The QIP payments will be linked to delivery of services under the MCP contracts and increase the amount of funding tied to quality outcomes. To receive QIP payments the DPH and University of California (UC) systems must achieve specified improvement targets, which grow more difficult through year-over-year improvement or sustained high performance requirements. The total funding available for the QIP payments will be limited to a predetermined amount (pool). 

Effective July 1, 2020, the Department has expanded the QIP program and added DMPHs.

MCPs, for any managed care questions regarding this program, please reach out the Hospital Directed Payment team PlanDP@dhcs.ca.gov.

Providers, for any managed care questions regarding this program, please reach out to the Hospital Directed Payment team at PublicDP@dhcs.ca.gov.

Program Authorities

Designated Public Hospital (DPH)

State Fiscal Year 2017/2018 (July 1, 2017, June 30, 2018)

• SFY 2017/2018 Directed Payments DPH QIP Preprint
• SFY 2017/2018 Uniform Increase DPH QIP Directed Payment Approval Letter

State Fiscal Year 2018/2019 (July 1, 2018 – June 30, 2019)

• SFY 2018/2019 Directed Payments DPH QIP Preprint
• SFY 2018/2019 Uniform Increase DPH QIP Directed Payment Approval Letter

Bridge Period (July 1, 2019 – December 31, 2020)

• July 1, 2019 – December 31 2020 DPH QIP 2.0 Directed Payment Approval Letter
• July 1, 2019 – December 31 2020 DPH QIP 2.0 Directed Payment Preprint
• DPH QIP PY 3 Preprint (Amended due to COVID-19)
• DPH QIP PY 3 COVID-19 Amendment Approval Letter
• DPH QIP PY 3.5 CMS Approval Letter
• DPH QIP PY 3.5 COVID-19 Amendment CMS Approval Letter
• DPH QIP PY 3.5 Preprint (Amended due to COVID-19)

CY 2021 – 2023 (January 1, 2021 – December 31, 2023)

• DPH QIP PY4-6 COVID-19 Revision Approval Letter
• DPH QIP PY4-6 COVID-19 Revision Preprint
• DPH QIP January 1, 2021 – December 31, 2023 Amendment Approval Package

CY 2024 (January 1, 2024 – December 31, 2024)

• CY 2024 DPH QIP Approval Package

CY 2025 (January 1, 2025 – December 31, 2025)

• CY 2025 DPH QIP Approval Package 

District and Municipal Public Hospital (DMPH)

• DMPH QIP January 1, 2025 – December 31, 2025 Approval Package
• DMPH QIP January 1, 2021 – December 31, 2023 Amendment Approval Package
• DMPH QIP PY 3.5 CMS Approval Letter
• DMPH QIP PY 3.5 COVID-19 Amendment CMS Approval Letter
• DMPH QIP PY 3.5 Preprint (Amended due to COVID-19)
• DMPH QIP PY4-6 COVID-19 Revision Approval Letter
• DMPH QIP PY4-6 COVID-19 Revision Preprint
• DMPH QIP PY4-6 COVID-19 Amendment (Approval Letter and Preprint)
• DMPH QIP PY7 CMS Approval Letter and Preprint
• CY 2025 DMPH QIP Approval Package

Resources

• Hospital Directed Payment Definition SFY 2017-2018 and SFY 2018-2019

Program Policies and Information

• QPL-18-001 QIP PY 1 Reporting.pdf
• QIP PY 1 Certification Form.pdf
• QPL-18-002 Minimum Number of Cases.pdf (SUPERSEDED BYQPL-19-001; Please review QPL-19-001)
• QIP Data Integrity Policy.pdf
• QPL-19-001 Minimum Reporting Requirements.pdf (SUPERSEDES QPL-18-002)
• QPL-19-002 QIP Measure Set PY 3 – This QPL informs all QIP Entities of the updated measure set and stratification requirements for PY 3 (July 1, 2019 – June 30, 2020).
• QPL-19-003 PY 2 Reporting – This QPL provides PY 2 reporting instructions for the QIP program.
• QPL-20-001 QIP PY 3Reporting and Payment Changes – This QPL informs all QIP Designated Public Hospitals and Health Systems (DPHs) of PY 3 (July 1, 2019 – June 30, 2020) reporting and payment changes for the QIP program.
• QPL-21-001 QIP PY 3.5 Updates Due to COVID-19 – This QPL informs all QIP entities of the changes to PY 3.5 reporting and performance requirements.
• QPL-21-002PY 3.5 PRIME Transition FluReporting – This QPL informs QIP Entities of necessary and required measurement and reporting instructions for the PRIME Transition measure1.3.3 – Preventative Care and Screening: Influenza Immunization.
• QPL-21-003 Policy Information for DMPH Measure Survey and Community Partner Application
• PY4 Program Policies
• PY 4 General Guidelines for QIP Data Collection and Reporting
• PY 4 Measure Set
• PY 4 Participating Entities
• QPL-21-005 – This QPL informs QIP entities and Medi-Cal Managed Care Health Plans of updates and clarifications for the PY 4 measure specifications for seven measures: Q-LBP, Q-URI, Q-AAB, Q-PCE, Q-FUA, Q-TRC, and Q-CCW.
• QPL-21-006 – PY 4 Race and Ethnicity Stratification
• QPL-21-007– Approved Community Partnerships for PY 4 and PY 5
• QPL-22-002– PY 4 Updates
• PY 5 Program Policies
• QPL-22-003 – Data Auditing Policies
• QPL-22-004 – Approved Community Partnerships for PY 5
• PY 6 Program Policies
• PY6 General Guidelines
• QPL-23-001 – PY 5 and PY 6 Race and Ethnicity Stratification
• QPL-23-002 – PY 5 Updates
• QPL-23-003 – Approved Community Partnerships for PY 6
• PY 5 Participating Entities
• QPL 24-001 PY6 Reporting Updates
• QPL 24-002 Data Integrity Policy Revision
• PY5 Measure Set
• PY6 Measure Set
• PY7 Measure Set
• QPL 24-003 PY7 Reporting Updates
• PY7 Program Policies
• PY7 General Guidelines
• QPL 24-004 QIP Policy Information for DMPH Measure Commitment Survey and Community Partner Application
• QPL 24-005 Approved Community Partnerships for PY7
• QPL 24-006 PY7 Q-DSF-E Reporting Update
• QPL 24-007 QIP PY7 FUx Measures Updates
• QPL 24-008 PY6 and PY7 Audit Update
• QPL 24-009 QIP DMPH Funding Pool PY8 Onwards
• PY6 Participating Entities (onwards)
• QPL 24-010 DMPH Measure Commitment Survey for PY8
• QPL 24-011 PY7 FUx Technical Specifications
• QPL 25-001 Require MCP-produced Baseline for Reporting FUx Measures
• QPL 25-002 CY 2024 Reporting Updates
• CY2025 Program Policies 
• CY2025 General Guidelines
• QPL 25-003 CY 2025 Q-BCS-E Reporting Update
• QPL 25-004 CY 2025 FUx, CCS, CIS, IMA, and CHL Technical Specifications
• QPL 25-005 CY 2025 Q-DSF-E Reporting Update
• QPL 25-006 CY 2025 Trending Break Measures
• CY 2025 Measure Set
• CY 2026 Measure Set
• QPL 25-007 Approved Community Partnerships for Calendar Year (CY) 2025
• QPL 26-001 QIP Policy Information for DMPH Measure Commitment Survey and Community Partner Application
• QPL 26-002 Approved Community Partnerships for Calendar Year (CY) 2026
• CY2026 Program Policies
• CY2026 General Guidelines

Data Sharing

• Data Sharing for the SFY 17-18 QIP Memorandum (9/10/2018)
• QIP Value Sets by Measure for MCPs for DPH Reporting (9/18/2018)
• QIP Reporting Manual PY1: for general guidance only (9/17/18)
• QIP_PY2_Value Sets_by_Measure_for_MCPs_for_DPH_Reporting_04_04_2019.xls
• QIP DATA SHARING FILE TEMPLATEv1.xls – This template is based on Inland Empire Health Plan’s (IEHP) PRIME Data Sharing File Template to provide IEHP’s County partners with PRIME data.
• QIP_PY3_Value Sets_by_Measure_for_MCPs_for_DPH_Reporting
• QIP-PY3.5-Value-Sets-by-Measure-for-MCPs-for-DPH-Reporting
• QPL-20-002 Data Sharing (SUPERCEDED BY QPL-21-004)
• QPL-21-004 Data Sharing (NEW-SUPERCEDES QPL-20-002)
• QIP PY4 Value Sets by Measure for QIP Entity/MCP Data Sharing – MCPs should provide the minimum necessary data to QIP entities by April 30, 2022.
• QPL-22-001 Data Sharing (SUPERCEDES QPL-21-004)
• QIP PY5 Value Sets by Measure for QIP Entity/MCP Data Sharing -MCPs should provide the minimum necessary data to QIP entities by April 30, 2023.
• QPL-22-005 Data Sharing (SUPERCEDES QPL-22-001)

QIP Evaluations

• Program Year 1: SFY 2017/2018
• Program Year 2: SFY 2018/2019
• Program Year 3: SFY 2019/2020
• Program Year 3.5: SFY July 2020 – December 2020
• Program Year 4: SFY January 1, 2021 – December 31, 2021
• Program Year 5: SFY January 1, 2022 – December 31, 2022
• Program Year 6: CY January 1, 2023 – December 31, 2023

Contact Us

For more information, please contact the QIP team at qip@dhcs.ca.gov.