Medicaid & CHIP Quality Reporting Across States as of August 18, 2022 – Proposed New Rule

The Proposed new rule describes mandatory reporting requirements to standardize Medicaid and CHIP quality measures nationally and promote health equity.
The Centers for Medicare & Medicaid Services has released a notice of proposed new rule promoting steady use of nationally standardized quality measures in Medicaid and the Children’s Health Insurance Program (CHIP). This is intended to help identify health disparities as well as gaps among all enrollees in these programs.
The rule requirements for mandatory yearly state reporting of three different quality measure sets:

• Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP
• Behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid
• Core Sets of Health Home Quality Measures for Medicaid

The three Core Sets are planned to measure the overall national quality of care for enrollees, state level performance monitoring, and enhance the quality of care.
CMS Administrator Chiquita Brooks-LaSure stated, “The Medicaid and CHIP Core Sets of quality measures for children, adults, and health home services are key to promoting health equity. They will allow us not only to identify health disparities but also to implement interventions based on the very data that make those disparities clear,. “CMS will use every lever available to ensure a high quality of care for everyone with Medicaid and CHIP coverage. By requiring states to report the core sets of quality measures, we can ensure that our policies are supported by data representing all of our beneficiaries.”
Quality measures assists with evaluating or quantifying processes, outcomes, patient perceptions, and organizational structures associated with providing quality health care. The Core Sets have different measures that is key to determining how well Medicaid and CHIP meet expectations of providing affordable, high quality, patient centered coverage to low income individuals, including families and children. The Core Sets can help CMS and various partners evaluate Medicaid and CHIP on a national level and across all programs that are run by states and Specifically, this will evaluate how Medicaid and CHIP coverage are meeting the needs of the community, including where health disparities persist, and how the quality of care can be improved for all.
CMS will also establish reporting requirements for states that choose to implement one or both of the optional Medicaid health home benefits under sections 1945 or 1945A of the Social Security Act, which measures health care quality for states that choose to establish “health homes.” Health homes will organize and integrate all primary, acute, behavioral health, and long-term services and supports for Medicaid’s most at-risk populations such as people with significant chronic conditions and/or serious mental health issues. The Health Home Core Sets allows CMS to keep track of the outcome of these optional state plan benefits, thereby improving the quality of health care for the more than 1 million Medicaid enrollees with chronic problems. At this time, the District of Columbia and 19 states have at least one health home program.
This process is still currently voluntary however, with this new rule reporting for all core sets including Child, behavioral health measures for adults, and the two Medicaid Health Home Core Sets are set to become mandatory in federal fiscal year 2024. Data reported in 2024 will reflect care delivered in calendar year 2023. Nationwide reporting of the measure sets will help with a chance to develop a national view of quality in the Medicaid and CHIP programs.
The Core Sets have the potential to assess changes in the quality of and access to health care provided by State Medicaid and CHIP programs over time and to compare programs across states. For example, the Core Sets capture data on the numbers of child and adult beneficiaries who have been seen by a provider following a hospitalization for mental illness, follow up care that is critical to improving health outcomes for individuals suffering from mental illness. The ability to assess the quality of and the access to care furnished by State Medicaid and CHIP programs is critical given the large number of vulnerable individuals who receive coverage in Medicaid and CHIP and the significant Federal and State resources needed to fund these programs.
There is a 60-day period for comments on the notice of proposed rulemaking that must be submitted to the Federal Register no later than October 21, 2022. For more information, or to review the entire rule, visit the Federal Register.

Share This Post

More To Explore