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Proposed rule
details mandatory reporting requirements to standardize Medicaid and CHIP
quality measures nationally and promote health equity The Centers for Medicare & Medicaid
Services (CMS) today released a notice of proposed rulemaking to promote
consistent use of nationally standardized quality measures in Medicaid and
the Children’s Health Insurance Program (CHIP). This will help identify gaps
and health disparities among the millions of people enrolled in these
programs. This rule proposes requirements for
mandatory annual state reporting of three different quality measure sets:
These Core Sets are designed to measure
the overall national quality of care for beneficiaries, monitor performance
at the state level, and improve the quality of health care. “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,” said CMS Administrator Chiquita Brooks-LaSure.
“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 help evaluate or
quantify processes, outcomes, patient perceptions, and even organizational
structures associated with providing high-quality health care. The Core Sets
include a range of measures key to determining how well Medicaid and CHIP
meet their missions of providing affordable, high-quality, person-centered
health coverage to low-income people, including children and families. In doing
so, the Core Sets can help CMS and partners evaluate Medicaid and CHIP
nationally and across the 54 programs run by states and territories.
Specifically, the Core Sets will evaluate how Medicaid and CHIP coverage is
meeting the needs of individuals and communities, including where health
disparities persist, and how the quality of care can be improved. In addition to the Child and Adult Core
Sets, CMS is establishing reporting requirements for states that elect to
implement one or both of the optional Medicaid health home benefits under
sections 1945 or 1945A of the Social Security Act, which will measure health
care quality for states that choose to establish “health homes.” Health homes
integrate and coordinate all primary, acute, behavioral health, and long-term
services and supports for one of Medicaid’s most at-risk populations: people
with significant chronic conditions and/or serious mental health concerns.
The Health Home Core Sets will allow CMS to monitor the impact of these
optional state plan benefits, thereby improving the quality of health care
for the more than 1 million Medicaid beneficiaries with chronic conditions.
Currently, 19 states and the District of Columbia have at least one health
home program. While currently voluntary, under this
new rule, reporting for the full Child Core Set, behavioral health measures
in the Adult Core Set, and the two Medicaid Health Home Core Sets becomes
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 create opportunities to develop a national view of quality in the
Medicaid and CHIP programs – a long-sought goal for public health advocates. There will be a 60-day comment period,
and comments on the notice of proposed rulemaking must be submitted to the
Federal Register no later than October 21, 2022. For more information, or to
review the rule in its entirety, visit the Federal
Register. ###
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Wednesday, August 31, 2022
CMS Releases Proposed Rule to Improve Medicaid & CHIP Quality Reporting Across States
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