DHCS Comprehensive Quality Strategy
On February 4, 2022 the Department of Health Care Services (DHCS) submitted the final draft 2022 DHCS Quality Strategy to the Centers for Medicare and Medicaid Services (CMS).
The Medicaid and Children's Health Insurance Program (CHIP) Managed Care Final Rule (42 Code of Federal Regulations (CFR) 438.340) requires each state Medicaid agency to produce a written quality strategy to assess and improve the quality of health care and services provided by all Medicaid managed care entities in that state. In response to this requirement, DHCS authored
the 2018 Medi-Cal Managed Care Quality Strategy report. The 2022 CQS report combines updates from the 2018 Medi-Cal Managed Care Quality Strategy report with updates and revisions to the DHCS Strategy for Quality Improvement in Health Care report.
The CQS report outlines DHCS' process for developing and maintaining a broader quality strategy to assess the quality of care that all Medi-Cal beneficiaries receive, regardless of delivery system. It also defines measurable goals, emphasizes Centers for Medicare & Medicaid Services (CMS) Core Set measures, and tracks improvement while adhering to the regulatory managed care requirements. The CQS report covers all Medi-Cal managed care delivery systems, including Medi-Cal managed care plans, county mental health plans, Drug Medi-Cal Organized Delivery Systems, and dental managed care plans, as well as non-managed care departmental programs.
The report also describes:
- DHCS' quality improvement infrastructure
- Development of the comprehensive quality strategy
- Managed care state standards, assessment, and evaluation requirements, including state-defined network adequacy standards
- Continuous program quality improvement and interventions
- The state's plan to identify, evaluate, and reduce health disparities
- The state's definition of ''significant change''
- Additional quality improvement efforts in DHCS programs that are not part of the managed care delivery system
Additionally, the CQS report highlights DHCS' coordinated delivery system reform efforts, including California Advancing and Innovating Medi-Cal (CalAIM), a multi-year initiative by DHCS to implement overarching policy changes across all Medi-Cal delivery systems. CalAIM's objectives include: 1) Reducing variation and complexity across delivery systems; 2) Identifying and managing member risk and need through population health management strategies; and 3) Improving quality outcomes and driving delivery system transformation through value-based initiatives and payment reform.
2022 Quality Strategy Report
Please visit the
Quality Measures & Reporting webpage for more information about other DHCS quality measures efforts and reports (e.g., monitoring reports and External Quality Review Organization reports).
2018 Quality Strategy Reports
Presentations
External Resources
