Medi-Cal Managed Care Quality Strategy
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The Medicaid Managed Care and CHIP Managed Care Final Rule (Final Rule), at 42 Code of Federal Regulations 438.340, requires each state Medicaid agency to implement a written quality strategy to assess and improve the quality of health care and services furnished by all Medicaid managed care entities in that state. The Department of Health Care Services (DHCS) intends to provide an updated Managed Care Quality Strategy Report on an annual basis to capture any significant changes within a twelve-month period. The public comment period was held from March 28 to April 27, 2018. DHCS is finalizing the report for submission to the Centers for Medicare & Medicaid Services (CMS) by the due date of July 1, 2018.
Beginning in 2018, the report encompasses quality strategies across all of California’s Medicaid managed care delivery systems, including: i) Managed Care Plans (MCPs); ii) County Mental Health Plans; iii) Drug Medi-Cal Organized Delivery Systems; and iv) Dental Managed Care plans. This report describes California’s Medicaid quality strategy, and how it meets the following requirements of the federal regulations:
The State-defined network adequacy standards
The State’s goals and objectives for continuous quality improvement, a description of the quality metrics, performance targets, and performance improvement projects
Arrangements for annual, external independent reviews
A description of the State’s transition of care policy
The State’s plan to identify, evaluate, and reduce health disparities
Policies regarding sanctions, and
The State’s definition of ‘‘significant change."
Please visit this webpage for more information on other DHCS' quality measures efforts and reports (e.g. monitoring reports and External Quality Review Organization reports). In addition, the table below provides an overview and comparison of various DHCS quality reports. The QSR described in this webpage is located in the last column of the table.
||Managed Care & Fee for Service
||Managed Care Plans
||All Managed Care Delivery Systems: MCPs, MHPs, DMC-ODS, and DMC plans|
- Describes the goals, priorities, guiding principles, and specific DHCS program activities related to quality improvement for Medi-Cal.
- Supports the DHCS Strategic Plan commitments and aligns with national efforts, such as the National Quality Strategy.
- This report is mainly used for internal purposes by DHCS programs and not submitted to CMS.
- Per Code of Federal Regulations (CFR) 438.202(a), States that have contracts with managed care organizations must have a written strategy for assessing and improving the quality of managed care services offered by all Medi-Cal managed care health plans.
- Evaluates MCPs' performance, updates progress toward measurable objectives for key indicators, establishes new targets for improvement, assesses past interventions, introduces future interventions and describes changes in service delivery, contractual standards, and enhanced oversight and monitoring of Medi-Cal managed care.
- Complies with CFR 438.340, which requires each state Medicaid agency to implement a written quality strategy to assess and improve the quality of health care and services furnished by all Medicaid managed care entities in that state.
- Supersedes the previous reporting requirement for CFR 438.202.
||Released annually in the spring
||Submitted to CMS and released annually in the fall from 2004-2017
||Submitted to CMS and updated annually|