CMS aims to mandate state quality reporting for Medicaid, CHIP

[MM Curator Summary]: 3 sets of core quality measures will be required, focusing on health homes and BH for adults and children’s health under CHIP.


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A nursing home employee assists an elderly patient who uses a cane. Adene Sanchez via Getty Images

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Dive Brief:

  • The CMS is proposing to standardize quality compliance for Medicaid and the Children’s Health Insurance Program nationwide and to require mandatory annual reporting from states for the first time.
  • The effort to improve Medicaid and CHIP reporting across the 54 programs run by states and territories would promote consistency in the quality of care for beneficiaries and help identify gaps and health disparities among the millions of people enrolled in the programs, the agency said Thursday.
  • Three core sets of quality measures are included under the proposed rule, covering health homes and behavioral health for adults under Medicaid and children’s health under both Medicaid and CHIP.

Dive Insight:

The number of Americans covered by Medicaid and CHIP has spiked during the COVID-19 pandemic as federal incentives to states to help keep people insured have boosted enrollment. The two programs covered a record one in four Americans last year.

Requiring states to evaluate and report on sets of data will help the CMS assess how well Medicaid and CHIP are doing in their mission to provide quality, affordable health coverage to low-income individuals and communities, the agency said.

Reporting of health measures in the three categories is currently voluntary but would become mandatory in the 2024 fiscal year under the new rule. Data on care delivered in 2023 would be the first reported.

The range of measurements to monitor performance will look at the processes, outcomes, patient perceptions and organizational structures involved in providing care.

“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 Administrator Chiquita Brooks-LaSure said in a statement. “CMS will use every lever available to ensure a high quality of care for everyone with Medicaid and CHIP coverage.”

The health home reporting requirements apply to states that opt to implement the voluntary Medicaid benefits. Health homes coordinate primary, acute, behavioral health and long-term services for people with significant chronic conditions or serious mental health challenges.

More than a million Medicaid beneficiaries have chronic conditions, and 19 states and the District of Columbia have at least one health home program.

The CMS is taking public comments on its proposed rulemaking through Oct. 21.


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