CMS of­fi­cials to dis­cuss qual­ity rating sys­tem for man­aged Med­i­caid

Modern Healthcare - - THE WEEK AHEAD - —Vir­gil Dickson

While there are many un­knowns in re­gard to the im­pact of the Trump ad­min­is­tra­tion on the healthcare in­dus­try, the CMS is dou­bling down on its ef­fort to re­struc­ture the na­tion’s healthcare de­liv­ery sys­tem to im­prove care while low­er­ing costs.

This week, the agency will gather se­nior CMS of­fi­cials, state reg­u­la­tors and pol­i­cy­mak­ers to dis­cuss the role of qual­ity rating sys­tems in driv­ing im­prove­ment, en­gag­ing ben­e­fi­cia­ries and en­hanc­ing ac­count­abil­ity in Med­i­caid man­aged-care pro­grams.

The CMS 2016 Qual­ity Con­fer­ence be­gins Tues­day in Bal­ti­more.

The CMS hopes to align Med­i­caid man­aged-care re­quire­ments with other ma­jor health cov­er­age pro­grams, en­hance pa­tient care and pro­mote qual­ity of care. Those is­sues will be high­lighted in a ses­sion fea­tur­ing Karen Mat­suoka, di­rec­tor for the Cen­ter for Med­i­caid and CHIP Ser­vices, and Dr. An­drey Ostro­vsky, the cen­ter’s chief med­i­cal of­fi­cer. Join­ing them will be se­nior Med­i­caid of­fi­cials from Michigan and New York, two states that have im­ple­mented qual­ity rating sys­tems for their man­aged­care plans.

Nine months ago, the CMS re­leased a fi­nal rule that cre­ated a qual­ity rat­ings sys­tem for Med­i­caid man­aged­care plans. The goal is to help con­sumers as­sess plans that are graded one to five stars, sim­i­lar to those that grade plans in Medi­care Ad­van­tage and on the mar­ket­place.

Plans will be eval­u­ated based on clin­i­cal qual­ity man­age­ment, mem­ber ex­pe­ri­ence, plan ef­fi­ciency, af­ford­abil­ity and man­age­ment.

In 2018, the CMS ex­pects to re­lease fi­nal guid­ance re­gard­ing mea­sures in the Med­i­caid star-rating sys­tem. States will have three years after the guid­ance is re­leased to be­gin rating man­aged­care plans.

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