CMS Offers Mandatory Quality Reporting Medicaid, CHIP

Under a proposed rule published Thursday, for the first time, states will be required to report on the quality of care that Medicaid and Children’s Health Insurance Program recipients receive.

The Centers for Medicare and Medicaid Services believe that mandatory reporting will promote fairness and consistent use of standardized measures of quality, and highlight differences between Medicaid and CHIP beneficiaries, the draft rule says.

If the regulation were finalized, states would have to report on three different sets of quality indicators each year for childcare, behavioral health, and health homes. The regulation stems from a 2018 law that requires reporting on Medicaid quality. Reporting on the Children’s Core Set, Adult Behavioral Health Measures, and Medicaid Health Home Core Set is voluntary under current rules and will become mandatory from FY2024 under the proposed rule.

“CMS will use all available leverage to ensure the highest quality of care for everyone with Medicaid and CHIP,” Administrator Chiquita Brooks-Lasur said in a press release. “By requiring states to report on a core set of quality metrics, we can ensure that our policies are supported by data that represents all of our beneficiaries.” The ruling is also intended to determine the quality and availability of Medicaid and CHIP coverage, she said.

The Affordable Care Act created Medicaid’s voluntary reporting on the original core set of adult health quality indicators that began in 2013. Since the program’s inception in 1997, states have been required to report certain CHIP metrics.

States that choose to establish “homes of health” will need to communicate how they coordinate primary, acute, mental health, and long-term care for Medicaid patients with serious chronic illness and serious mental illness. Nineteen states and the District of Columbia have at least one health house program. Last month, CMS also released a set of voluntary quality assurance measures for Medicaid home and community programs.

According to CMS, the average state reports 73% quality scores for the core set for children and 67% scores for the core set for adults. States do not report anything on measures such as depression screening and follow-up treatment and do not adhere to the technical specifications of other measures, the proposed rule says. The agency writes that most states also do not report measures for all beneficiaries.

“Changes to state-by-state reporting have left some populations behind in quality improvement efforts and made meaningful cross-state comparisons more difficult,” the proposed rule says.

CMS asks for comment on whether five years is an appropriate time frame for a phased stratification of measures and how it can provide effective technical assistance to help implement the regulation.

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