NASHP

NOVEMBER 8, 2024

A growing trend in state health policy is developing capitated managed care programs to provide long-term services and supports (LTSS) to Medicaid beneficiaries who are older and/or have disabilities. Cardinal Care currently enrolls 90 percent of all Medicaid beneficiaries into MCOs.

Medicaid 52

Medicaid Nursing Quality Improvement Accountability 52

NASHP

DECEMBER 10, 2021

The information on this map comes from a 50-state survey of a variety of stakeholders, ranging from Medicaid officials to Community Health Workers, on their states’ approaches?to?integrating?CHWs ACO Accountable Care Organizations. MHP Medicaid Health Plans. NCQA National Committee for Quality Assurance. integrating?CHWs

Medicaid 122

Medicaid Primary Care Prevention Nursing 122

NASHP

AUGUST 23, 2021

Primary care case management (PCCM) programs are one of the oldest types of Medicaid managed care, but over time most states have shifted to use managed care organizations (MCOs) to deliver services to Medicaid participants. million Medicaid participants. million Medicaid enrollees.

Primary Care 64

Primary Care Medicaid Accountability Quality Improvement 64

NASHP

APRIL 17, 2023

Performance measurement is a pillar of state Medicaid managed care quality improvement and oversight efforts, is often factored into plan payment, and supports public reporting. 42 Medicaid agencies collected at least one measure of behavioral health performance. In a few states we also used additional resources.

Medicaid 52

Medicaid Quality Assurance Quality Review Accountability 52

GoMoHealth

OCTOBER 20, 2022

By Nakecia Taffa, Quality Improvement and Health Equity Director for GoMo Health. This led me to GoMo Health, where we create, activate and scale these improvements daily. While most managed care organizations go to great lengths to comply with Medicaid and Medicare mandates, many are still struggling to meet their goals.

Quality Improvement 87

Quality Improvement Medicaid Population Health Medicare 87

Healthcare ECONOMIST

JANUARY 14, 2022

Most individuals in its catchment area were Medicaid or Medicare beneficiaries or uninsured, representing the densest noncommercial payor communities for nonpublic hospitals in the country. Before the merger, funding was lacking for technology and infrastructure investments to support quality improvement. Information technology.

Hospitals 75

Hospitals Rehabilitation Accountability Quality Improvement 75

Sheppard Health Law

OCTOBER 27, 2021

On October 20, 2021, the Centers for Medicare and Medicaid (“ CMS ”) Innovation Center (“ Innovation Center ”) published a white paper detailing its vision for the next ten years: a health system that achieves equitable outcomes through high quality, affordable, person-centered care. Strategic Objective 2: Advance Health Equity.

Medicaid 52

Medicaid Medicare Accountable Care Accountability 52

NASHP

SEPTEMBER 8, 2023

Over the past two years, the seven state teams that participated in the MCH PIP Policy Academy, comprised of officials from state Medicaid, public health, and other relevant agencies/groups (e.g., The state Medicaid agency is in the process of standing up this case management program based on input received during these sessions.

Medicaid 80

Medicaid Performance improvement Quality Improvement Accountable Care 80

NASHP

SEPTEMBER 27, 2024

As part of a continuum of home- and community-based services (HCBS), respite can improve families’ quality of life [4] , [5] and help improve outcomes, including promoting more stable living situations. [6] Additional state examples from Colorado and Massachusetts were gleaned from NASHP’s Respite Summit, held in February 2024.

Medicaid 59

Medicaid Nursing Medicare Quality Improvement 59

Home Health Care

NOVEMBER 22, 2022

Government Accountability Office (GAO) has signed off on the home health payment rule finalized by the Centers for Medicare & Medicaid Services (CMS) last month. CMS argues that alternatives to mitigate the payment reductions would be contrary to the intent of the rule.

Medicare 85

Medicare Medicaid Quality Improvement Accountability 85

NCQA

DECEMBER 18, 2024

How NCQA’s Work Supports This Goal NCQA created the Race and Ethnicity Stratification Learning Network to investigate the challenges and opportunities of using race and ethnicity data for quality improvement, to gather insights on how plans are overcoming challenges and to get an early look at HEDIS measures stratified by race and ethnicity.

Quality Assurance 52

Quality Assurance Accountability Quality Improvement Pharmaceuticals 52

Sheppard Health Law

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”). Additional Opportunities for Integration through State Medicaid Agency Contracts.

Medicare 98

Medicare Medicaid Integration Regulations 98

HIT Consultant

OCTOBER 21, 2022

This work occurs alongside evaluating how to integrate the medical device into the hospital system’s diagnostic paradigms, including in relation to quality improvement programs. Sepsis accounts for the highest in-patient deaths and costs and is additionally the most under-reimbursed for diagnosis and treatment.

Hospitals 98

Hospitals Quality Improvement Medicaid Clinical Practice 98

NASHP

APRIL 15, 2022

CalAIM: Leveraging Medicaid Managed Care for Housing and Homelessness Supports April 15, 2022 / by Allie Atkeson. Driven by challenges facing individuals with complex care needs, states are increasingly working to address the physical, behavioral, and social needs of their Medicaid beneficiaries. Download the report (PDF).

Medicaid 59

Medicaid Public Hospital Hospitals Nursing 59

NASHP

OCTOBER 20, 2022

This substandard access to quality care can lead to poor health outcomes.[6]. have a special health care need, and an estimated 44 percent of CYSHCN are enrolled in Medicaid.[7] public health, Medicaid, mental health) and other stakeholders (e.g., Nearly 20 percent of children in the U.S.

Medicaid 98

Medicaid Integration Accountability Quality Improvement 98

Briggs Healthcare

OCTOBER 19, 2021

population, NH residents account for nearly 33% of all COVID-19 deaths. The Center for Medicare and Medicaid Services implemented sweeping telemedicine (TM) regulatory relief in an effort to reduce COVID-19 spread in NHs. “Nursing homes (NHs) have been at the frontline of the COVID-19 pandemic. Despite representing <1% of the U.S.

Telemedicine 52

Telemedicine Nursing Health Science Quality Improvement 52

NASHP

MARCH 22, 2024

State Medicaid programs, behavioral health authorities, public health, departments of insurance, human and social service agencies, departments of education, departments of corrections, housing, and employment can collaborate to align overlapping efforts, align policies, and braid funding and accountability mechanisms.

Accountability 52

Accountability Medicaid Primary Care Quality Improvement 52

NCQA

OCTOBER 31, 2023

“ It’s a marathon, not a sprint ,” said Liz Fowler, Director at the Center of Medicare and Medicaid Innovation (CMMI), during a recent Fireside Chat with NCQA Executive Vice President Eric Schneider. And then we’re also developing an approach for certification based on quality improvement and patient experience.”

Primary Care 52

Primary Care Quality Improvement Medicaid Accountable Care 52

NASHP

JUNE 22, 2023

Medicaid covers more than 40 percent of births nationally. Given the critical role that Medicaid plays in maternal health, there is a longstanding interest in the role of Medicaid service delivery systems to improve perinatal health outcomes. All Medicaid beneficiaries served by the practice are included.

Medicaid 59

Medicaid Prevention Accountability Medicare 59

NCQA

OCTOBER 9, 2024

They’ll explain how to leverage data to uncover members who are experiencing health disparities, identify the clinical and social drivers of those disparities, develop strategic partnerships with clinicians and care delivery systems and implement quality improvement efforts.

Primary Care 52

Primary Care Medicaid Integration Quality Improvement 52

NASHP

MARCH 28, 2022

State Medicaid-funded long-term services and supports (LTSS) systems are not well-positioned to compete for this shrinking pool of workers. Responsible for 43 percent of all LTSS expenditures , state Medicaid programs have a major role to play in responding to this crisis. These funds must be spent before March 31, 2024.

Nursing 98

Nursing Medicaid Home Care Rehabilitation 98

Healthcare Leadership Council

MAY 25, 2022

Crippen, former director of the Congressional Budget Office and currently a Healthcare Leaddership Council consultant, that should be a catalyst for discussion on a critical element of the Center for Medicare and Medicaid Innovation’s future direction.

Medicare 75

Medicare Medicaid Accountable Care Quality Improvement 75

NASHP

AUGUST 31, 2023

State leaders play a critical role in convening key internal and external partners, implementing engagement and input processes that foster shared ownership and accountability toward goals at the state and community levels.

Medicaid 52

Medicaid Accountability Public Health services Population Health 52

Healthcare ECONOMIST

OCTOBER 4, 2021

The Government Accountability Office (GAO) last week published a report evaluating the Merit-based Incentive Payment System (MIPS). MIPS evaluates provider value along four dimensions: (1) quality, (2) improvement activities, (3) promoting interoperability, and (4) cost.

Medicare 105

Medicare Quality Improvement Quality of Care Accountability 105

Home Health Care

OCTOBER 28, 2022

How did you measure the quality of that data and quantify those values in a comparable and accessible way? Longo : There are nearly 11,000 home health agencies that report data to the Centers for Medicare and Medicaid Services. The relationship between higher star ratings and accreditation seems to reflect that commitment to quality.

Patient Safety 76

Patient Safety Performance improvement Quality Improvement Accountability 76

Sheppard Health Law

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Additional Opportunities for Integration through State Medicaid Agency Contracts (§ 422.107).

Medicare 52

Medicare Medicaid Accountability Integration 52

NASHP

MARCH 22, 2024

In addition to expanding Medicaid, North Carolina’s FY2024 budget allocates over $835 million for mental health and substance abuse investments under Medicaid. They focus on crucial areas such as managed care contracting, achieving coverage parity, and enhancing workforce capacity to improve both quality and access to care.

Medicaid 52

Medicaid Urgent Care Primary Care Hospitals 52

NASHP

FEBRUARY 27, 2024

This report is one section of State Strategies to Leverage Medicaid Managed Care Contracting for Investments in Health and Housing Alignment. For more information on financing housing-related services, please visit our Medicaid and Housing toolkit. Flexible services are not Medicaid-covered services, nor are they an entitlement.

Medicaid 40

Medicaid Quality Improvement Accountable Care Accountability 40

NASHP

NOVEMBER 29, 2021

Medicaid Reimbursement. Medicaid Reimbursement. Alabama does not reimburse for CHW services through its Medicaid program. Alaska Medicaid reimburses for CHW services through MCOs as authorized under the state plan. Arizona does not currently reimburse for CHW services through its Medicaid program.

Medicaid 52

Medicaid Primary Care Prevention Nursing 52

Briggs Healthcare

MARCH 20, 2023

and Jonathan Blum, Centers for Medicare & Medicaid Services – names you may recognize from CMS National Stakeholder Calls. As the nation’s largest payer for health care, the Centers for Medicare & Medicaid Services’ (CMS) mission in our National Quality Strategy includes ensuring everyone is safe when they receive care.

Patient Safety 40

Patient Safety Medicaid Medicare Quality of Care 40

NASHP

MARCH 22, 2024

States such as Texas, Wyoming , and New Jersey are adopting Medicaid reimbursement of collaborative care services and are addressing capacity to transition to CoCM. Integration of Substance Use Services and Supports States can align long siloed approaches to primary care, mental health, and substance use services through integration efforts.

Medicaid 52

Medicaid Integration Primary Care Nursing 52

Briggs Healthcare

APRIL 5, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare On April 17, 2023, the Centers for Medicare & Medicaid Services (CMS) will transition to the Internet Quality Improvement and Evaluation System (iQIES) for Minimum Data Set (MDS) record submissions and reports.

Accountability 52

Accountability Nursing Medicare Quality Improvement 52

NASHP

DECEMBER 20, 2022

This approach requires significant coordination among policymakers from across state systems – behavioral health, Medicaid, courts, and corrections – to share resources, align policies, and develop clear protocols for programming. D)(1) of these regulations, or are treated for an opioid overdose.

Medicaid 52

Medicaid Prevention Hospitals Integration 52

NASHP

DECEMBER 23, 2022

With more than 40 percent of births financed by Medicaid, the Centers for Medicare & Medicaid Services (CMS) has developed an action plan that corresponds with goals outlined in the White House blueprint. Implement Medicaid benefit. Monitor and evaluate quality improvement and outcomes and address barriers to care.

Medicaid 59

Medicaid Nursing Hospitals Regulations 59

NASHP

APRIL 24, 2023

Access to quality health services is essential as most preventable pregnancy-related deaths are attributed to mental health and cardiac and coronary conditions. births, Medicaid and the Children’s Health Insurance Program (CHIP) are critical in addressing this maternal health concern. As the payor of over 40 percent of U.S.

Medicaid 52

Medicaid Prevention Accountability Quality Improvement 52

Home Health Care

AUGUST 15, 2022

of the Medicare fee-for-service population, homebound seniors aged 70 and older accounted for 11% of Medicare spending in 2015, according to the study. In light of these findings, the homebound represent a critically important population to target for quality improvement and reductions in Medicare spending.”.

Medicare 97

Medicare Primary Care Medicaid Quality Improvement 97

NASHP

JUNE 22, 2022

public health, Medicaid, mental health) and other stakeholders (e.g., health plans, providers, families of CYSHCN) in using, adapting, and implementing the National Care Coordination Standards for CYSHCN to develop or improve care coordination systems. State Medicaid agencies. Oversee and incentivize quality care.

Care Transition 52

Care Transition Medicaid Doctors Regulations 52