Aug 28 -- The Centers for Medicare & Medicaid Services, Health and Human Services (HHS) invites comments to OMB by October 12, 2023 regarding data collections from states related to proposed revised Children's Health Insurance Program Managed Care and Supporting Regulations. [Comments due 30 days after submission to OMB on September 12, 2023.]
States must provide information obtained through methods consistent with the Protocols specified by CMS to External Quality Review Organization (EQRO). States must post the EQR technical reports on their websites to help enrollees and potential enrollees make informed choices when selecting providers. It also gives advocacy organizations, researchers, and other interested parties access to information pertaining to: the quality of care provided to beneficiaries enrolled in CHIP managed care organizations (MCO), prepaid inpatient health plans (PIHP), and prepaid ambulatory health plans (PAHP). The quality ratings system (QRS) provides beneficiaries with information that allows them to make an informed choice when comparing and selecting managed care plans. The information also provides a better understanding of the state's quality improvement goals and objectives, and how the state is measuring the progress of its goals. The information may assist states in comparing the outcomes of different delivery systems and can assist them in identifying future performance improvement subjects.
This iteration is associated with the changes proposed in our May 3, 2023 (88 FR 28092) NPRM (CMS-2439-P; RIN 0938-AU99) which would advance CMS’s efforts to improve access to care, quality and health outcomes, and better address health equity issues for Medicaid and CHIP managed care enrollees. The proposed rule would strengthen standards for timely access to care and states’ monitoring and enforcement efforts; enhance quality as well as fiscal and program integrity standards for Medicaid state directed payments (SDPs); specify the scope of in lieu of services and settings to better address health-related social needs (HRSNs); further specify medical loss ratio (MLR) requirements; and establish a framework and other requirements for states to implement a quality rating system (QRS) to compare and framework Medicaid and CHIP managed care plans.
Our overarching goal for these regulations is to align CHIP managed care standards with those of the Marketplace and Medicaid where practical to ensure consistency across programs. As discussed in section I of the preamble, in the final rule, we are revising existing Medicaid regulations in order to modernize managed care contracting and service delivery while improving health care outcomes and beneficiary experience in a cost-effective manner. To the extent appropriate, the final and proposed regulations for CHIP are aligned with the revisions made for Medicaid.
CMS Quality of Care External Quality Review:
https://www.medicaid.gov/medicaid/quality-of-care/medicaid-managed-care/quality-of-care-external-quality-review/index.html
Draft data collection and supporting statements:
https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=202308-0938-005
FRN:
https://www.federalregister.gov/d/2023-18520 #2
