NASHP

APRIL 20, 2023

State Medicaid agencies are taking proactive steps to ensure quality of care and access to behavioral health services. MCOs may earn the withheld amount by performance on six measures that have been divided into three categories: quality improvement (three measures), care management (one measure), and behavioral health (two measures).

Medicaid 96

Medicaid Quality Improvement Quality of Care Integration 96

Home Health Care

APRIL 28, 2023

Centers for Medicare & Medicaid Services (CMS) proposed a new rule that would make major changes to the way that home care workers are compensated under Medicaid. The bulk of its business is in Medicaid. Anderson also noted that home care agencies working under Medicaid often vary in size. On Thursday, the U.S.

Medicaid 98

Medicaid Accountability Quality Assurance Home Care 98

NASHP

APRIL 17, 2023

Performance measurement is a pillar of state quality improvement and oversight. In addition, starting in 2024, federal rules will require states to report performance on some measures, including some behavioral health measures, to the Centers for Medicare & Medicaid Services (CMS).

Medicaid 52

Medicaid Quality Assurance Quality Improvement Quality Review 52

NASHP

DECEMBER 16, 2022

States provide access to contraception under their Medicaid programs in various ways. Medicaid paid for 41% of all U.S. Public insurance programs, including Medicaid, the Children’s Health Insurance Program (CHIP), and the Indian Health Service (IHS) paid for over two-thirds (68%) of unintended births in 2010. births in 2021.

Medicaid 52

Medicaid Prevention Quality Improvement Hospitals 52

NCQA

JULY 16, 2024

In our recent Fireside Chat, we brought together two forward-looking health care leaders united in their commitment to quality and their passion for improving care for Medicaid populations. 1115 waivers are special demonstrations that allow states to pilot new Medicaid approaches outside federal program rules.

Medicaid 86

Medicaid Quality Improvement Integration Population Health 86

NASHP

MARCH 22, 2024

States are increasingly turning to capitated Medicaid managed care programs to deliver long-term services and supports (LTSS) to individuals with complex needs. pdf On October 1, 2023, Virginia Medicaid combined its two managed care programs of Medallion 4.0

Medicaid 75

Medicaid Nursing Medicare Integration 75

NASHP

MAY 26, 2023

It is one of the most desired caregiver services , and Medicaid is one policy lever to fund it. Through Medicaid’s federal-state partnership and under a variety of home and community-based services (HCBS) coverage authorities, states have the flexibility to design HCBS to meet the long-term care needs of their populations.

Medicaid 121

Medicaid Nursing Regulations Integration 121

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

Health Policy News

NOVEMBER 16, 2022

Mandatory Medicaid and Children’s Health Insurance Program (CHIP) Core Set Reporting In August 2022, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule, which, if promulgated, would.

Medicaid 52

Medicaid Medicare Quality Improvement 52

Readiness Rounds

DECEMBER 4, 2024

How Can We Improve Quality and Patient Outcomes? What Are the Steps for Integration into Quality Improvement? How Can We Improve Data Management and Staff Training? One of the most transformative changes ahead is the CMS 2025 Age-Friendly Measures, introduced by the Centers for Medicare & Medicaid Services.

Quality Improvement 52

Quality Improvement Physical Therapy Integration Hospitals 52

NASHP

NOVEMBER 15, 2021

Immunization Barriers in the United States: Targeting Medicaid Partnerships Fact Sheet: Using New and Existing Federal Funds to Modernize IIS. What tasks can support IIS interoperability, integration, and outreach with partner systems like Medicaid and Public health? What gaps can be filled to help facilitate public health activity?

Medicaid 52

Medicaid Quality Improvement Prevention Integration 52

Briggs Healthcare

MAY 30, 2023

MEASURE RATIONALE: Findings from an environmental scan/literature review suggest there is a measurement gap for assessing discharges to non-institutional settings for high-risk and high-need populations across Medicaid. assisted living, adult family home, group home). The potential measure exclusions. a qualifying numerator event).

Medicaid 40

Medicaid Rehabilitation Quality Improvement Quality of Care 40

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

Healthcare ECONOMIST

SEPTEMBER 25, 2023

They find that: We did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality (beta = −0.04 Interestingly, the authors did find that there was some evidence of quality improvement among insured non-Medicaid patients.

Quality of Care 77

Quality of Care Medicaid Quality Improvement Hospitals 77

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

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

HIT Consultant

FEBRUARY 8, 2024

Elissa Toder, MBA, VP of Quality Improvement Strategy & Solutions at Reveleer In the ongoing transition to value-based care (VBC), provider contracting poses challenges for health plans and providers. In that case, the payer must invest resources in consolidating this data to manage quality measures effectively.

Quality Improvement 105

Quality Improvement Data Acquisition Medicaid Performance improvement 105

p3care

MAY 31, 2024

Enhancing Quality By examining doctors’ performance, ACOs identify strengths and weaknesses in the service of healthcare delivery. It does not restrict itself to temporary or timely reporting only but fosters continuous quality improvement. Complying with all these regulations helps in avoiding penalties.

Quality of Care 130

Quality of Care Doctors Medicare Patient Experience 130

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 96

Quality Improvement Medicaid Population Health Medicare 96

NCQA

AUGUST 15, 2024

Medicaid Demonstration Programs. States can cover CCBHC services through Medicaid demonstration programs. Some states cover CCBHC services with additional funding outside their Medicaid program. There are more than 450 active grantees nationwide; more grants will be available in the coming years. State Funding.

Medicaid 52

Medicaid Quality Improvement Integration 52

NCQA

FEBRUARY 14, 2023

To better measure health equity in new ways that integrate performance measures, a new NCQA policy brief reviews four measurement approaches for states’ Medicaid managed care programs. An examination of peer-reviewed and gray literature uncovered four criteria for measuring equitable care: Select indicators of social determinants of health.

Medicaid 52

Medicaid Quality Improvement Integration Medicare 52

Briggs Healthcare

FEBRUARY 24, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare The 2023 CMS Quality Conference, brought to you by the Centers for Medicare & Medicaid Services, is the premier health care quality conference focused on improving quality, equity, and innovation. Register here.

Quality Improvement 52

Quality Improvement Medicaid Medicare Healthcare 52

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

Briggs Healthcare

MAY 9, 2023

During the virtual conference, which attracted 10,000 attendees, CMS released a National Quality Strategy (NQS) handout , which outlines the goals and objectives, and actions taken within the NQS’s four priority areas: equity and engagement; outcomes and alignment; safety and resiliency, and interoperability and scientific advancement.

Quality Improvement 52

Quality Improvement Medicaid Medicare Hospitals 52

Home Health Care

MARCH 1, 2024

Beyond geographic PACE expansion, the National PACE Association also sees a future where the model evolves to reach a larger demographic of seniors, including those that fall outside of the category of Medicaid-eligible. I’d say 90% of people that are currently served by PACE are eligible for Medicaid.

Medicaid 124

Medicaid Medicare Primary Care Quality Improvement 124

HIT Consultant

FEBRUARY 15, 2022

Medicaid, Medicare Advantage). public Medicaid, private PPO, Medicare Advantage). Health plans should approach quality improvement with a prioritized, targeted approach, first addressing the biggest pain points that were revealed within a deeper analytics exercise, such as access to care. – Geographic location.

Quality Improvement 98

Quality Improvement Medicare Medicaid Healthcare 98

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

SEPTEMBER 23, 2024

Medicaid agencies will already have a rate setting function that may be sufficient. Medicaid agencies will already have a rate setting function that may be sufficient. Other functions • Contracting • Business office • Information technology • Human resources • States may be able to use existing infrastructure.

Quality Improvement 52

Quality Improvement Medicaid Hospitals Healthcare 52

HIT Consultant

APRIL 26, 2023

About the Race and Ethnicity Stratification Learning Network The Race and Ethnicity Stratification Learning Network was convened in late-2022 to develop a greater understanding and resources to support the stratification of quality performance data and use of stratified data to advance health equity.

Quality Assurance 52

Quality Assurance Quality Improvement Medicaid Medicare 52

Briggs Healthcare

MARCH 8, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare The Centers for Medicaid and Medicare Services (CMS) is migrating MDS submissions and reporting to a new system, the internet Quality Improvement and Evaluation System (iQIES) beginning April 17, 2023.

Quality Improvement 40

Quality Improvement Nursing Medicaid Medicare 40

HIT Consultant

JULY 13, 2022

. – Cohere’s collaborative UM platform will help GHP support value-based care delivery, reduce administrative costs, and lead the nation in aligning quality improvement initiatives across all its lines of business, including Commercial, Exchange, Medicare Advantage, and the newly expanded Medicaid.

Medicaid 98

Medicaid Quality Improvement Medicare 98

NASHP

AUGUST 15, 2022

Improving Oral Health Access through Managed Care Quality Initiatives in Pennsylvania By Allie Atkeson. States are engaged in a variety of efforts to improve oral health access as part of improving overall health outcomes for Medicaid members. Medicaid Managed Care Dental Performance. Conclusion.

Medicaid 52

Medicaid Quality Review Prevention Quality Improvement 52

p3care

DECEMBER 10, 2020

MIPS program has four categories that cater to meaningful quality healthcare services. Improvement Activities (IA). The quality category replaced the PQRS (Physician Quality Reporting System) and reflects the efforts to improve the quality of care. Key Elements of QPP MIPS. Promoting Interoperability (PI).

Quality of Care 246

Quality of Care Medicare Quality Improvement Medicaid 246

Briggs Healthcare

AUGUST 7, 2023

Mary Madison, RN, RAC-CT, CDP Clinical Consultant – Briggs Healthcare The submission deadline for the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) is approaching. All data must be submitted no later than 11:59 p.m. on August 15, 2023.

Medicaid 40

Medicaid Quality Improvement Medicare Nursing 40

Healthcare It News

OCTOBER 12, 2023

In 2022, the Centers for Medicare & Medicaid Services introduced new CPT codes for remote care delivered via a digital care management platform that qualifies with the Federal Drug Administration as software as a medical device (SaMD). Another aspect of this approach is reimbursement.

Digital Care 258

Digital Care Physical Therapy Patient Experience Remote Care 258

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 105

Medicare Medicaid Quality Improvement Accountability 105