Kaiser Family Foundation Survey on State Medicaid Managed Care ...

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V. QUALITYAll states with comprehensive RB-MCOs or PHPs or operating a PCCM program should complete this section.1. Accreditationa. Do you require RB-MCOs to be accredited?i. If “yes,” please indicate the type(s) of accreditation accepted (Check all that apply)NCQA, URAC AAAHC Other:ii. If “no,” indicate if accreditation is rewarded in one or more of the following ways. (Check all that apply)A. Additional RFP technical points awarded if accreditedB. Auto-assignment algorithm favors accredited plansC. Higher Medicaid payments available for accredited plansD. Other:b. Do you require PHPs to be accredited?i. If “yes,” please indicate the type(s) of accreditation accepted (Check all that apply)NCQA, URAC AAAHC Other:ii. If “no,” indicate if accreditation is rewarded in one or more of the following ways. (Check all that apply)A. Additional RFP technical points awarded if accreditedB. Auto-assignment algorithm favors accredited plansC. Higher Medicaid payments available for accredited plansD. Other:c. Is deeming of EQR requirements done for accredited RB-MCOs?d. Is deeming of EQR requirements done for accredited PHPs?2. Performance Measuresa. Does your state use performance measures (including HEDIS© or HEDIS©-like measures) to assess clinical qualityor access?If “yes”:i. Please indicate below in which delivery systems clinical quality or access performance measures are usedand the number of measures used in FY 2011. If clinical quality or access performance measures are usedin a PCCM delivery system, please indicate under “Comments” whether survey reports are available byPCP. (Enter “NA” if the delivery system model is not used in your state.)A. Performance measures Used?B. Number of Measures Used in 2011Fee-for-ServicePCCMComprehensiveRB-MCONon-comprehensivePHPComments:ii. Are health plans required to submit HEDIS© or HEDIS-like measures to NCQA?A. If “no,” indicate whether one or more plans voluntarily submit HEDIS© or HEDIS-like measuresto NCQA:iii. Does the state provide race and ethnicity data to plans for use in HEDIS© or other performance measureanalysis?iv. On Appendix II, please indicate the clinical quality or access performance measures that your statecurrently uses to measure plan performance.K A I S E R C O M M I S S I O N O NMedicaid and the Uninsured11HEALTH MANAGEMENT ASSOCIATES
. Does your state use CAHPS© surveys to assess member satisfaction? If “yes”:i. Does your state require the child, adult or both versions of CAHPS?ii. Are health plans required to submit CAHPS© survey results to NCQA?A. If “no,” indicate whether one or more plans voluntarily submit CAHPS survey results to NCQA:iii. Please indicate below in which delivery systems CAHPS© surveys are used and how often they areperformed (e.g., annually, every two years, etc.). If CAHPS surveys are used in a PCCM delivery system,please indicate under “Comments” whether survey reports are available by PCP. (Enter “NA” if the deliverysystem model is not used in your state.)A.CAHPS© Used?B. Frequency of <strong>Survey</strong>sFee-for-ServicePCCMComprehensiveRBMCNon-comprehensivePHPComments:3. External Quality Reviewa. As of October 1, 2010, did your state have an EQRO contract?b. If your state conducts quality focus studies, please briefly describe or name the most recent focus studies:4. Quality Reportinga. Does your state publicly release quality performance reports for:i. RB-MCOs? ii. PCCM? iii. PHPs? iv. Fee-for-service delivery system?Comments:b. If you answered “yes” to any part of (a) above, are these reports available on the internet?:i. If “no,” how can these reports be accessed? Please briefly describe:c. Does your state prepare a report card that enrollees can use to compare health plan performance when choosinga plan?i. If “yes,” please briefly describe the data reported:d. As required by the Children’s Health Insurance Program Reauthorization Act, HHS has developed and postedfor public comment an initial core set of children's health care quality measures for voluntary use by Medicaidand CHIP programs. Please indicate whether your state is planning to report on:5. Quality Initiativesa. Has your state undertaken any initiatives to monitor or improve emergency room use, misuse or overuse?i. If “yes,” please briefly describe including whether the initiative is/was viewed as successful:b. Has your state undertaken any initiatives to monitor or improve obesity rates?i. If “yes,” please briefly describe including whether the initiative is/was viewed as successful:c. Has your state undertaken any initiatives to monitor or improve racial/ethnic disparities?K A I S E R C O M M I S S I O N O NMedicaid and the Uninsured12HEALTH MANAGEMENT ASSOCIATES
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kaisercommission onmedicaidand theu
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Table of ContentsExecutive Summary
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EXECUTIVE SUMMARYMedicaid, the publ
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party enrollment brokers to provide
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HEDIS©, CAHPS©, and state-specifi
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ConclusionFor over 30 years, state
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from the recession and the slow rec
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A note on Medicaid managed care ter
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Managed caremodelTable 1: Medicaid
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States are increasingly mandating m
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States with Medicaid MCOsKey Sectio
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States have “auto-assignment” a
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excess of a specified threshold for
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Dental care and outpatient and inpa
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the second trimester, and within th
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eported that they limit PCP panel s
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States with non-comprehensive PHPsK
Page 39 and 40: Measuring, monitoring, and improvin
Page 41 and 42: seven states required 10 measures o
Page 43 and 44: CAHPS© surveys. North Carolina is
Page 45 and 46: Special initiatives to improve qual
Page 47 and 48: public health efforts to reduce dis
Page 49 and 50: Medicaid managed long-term care and
Page 51 and 52: (e.g., need to credential Adult <st
Page 53 and 54: In many states, broader efforts foc
Page 55 and 56: Looking ahead: Medicaid managed car
Page 57 and 58: ConclusionFor over 30 years, state
Page 59 and 60: APPENDIX 2: Summary of Medicaid Man
Page 61 and 62: Program Name(e.g., Popular Name, 19
Page 63 and 64: APPENDIX 3: MCO Contracts, Plan Cha
Page 65 and 66: State(No. ofcontracts)NameEnrollmen
Page 67 and 68: State(No. ofcontracts)NameEnrollmen
Page 69 and 70: APPENDIX 5: MCO Capitation Rate-Set
Page 71 and 72: APPENDIX 7: MCO Network Adequacy Re
Page 73 and 74: State Primary Care Obstetric Care S
Page 75 and 76: APPENDIX 9: Providers Recognized as
Page 77 and 78: APPENDIX 11: PCCM Administrative Se
Page 79 and 80: APPENDIX 13: Initiatives to Improve
Page 81 and 82: I. MANAGED CARE OVERVIEW1. Total Ma
Page 83 and 84: 4. Enrollment Requirements.a. We ar
Page 85 and 86: ii. Please indicate whether the fac
Page 87 and 88: c. Required Providers: We are inter
Page 89: IV. NON-COMPREHENSIVE PREPAID HEALT
Page 93 and 94: VI. SPECIAL INITIATIVESAll states s
Page 95 and 96: Appendix I: Managed Care Contracts1
Page 97: Appendix II: Clinical Quality Perfo
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