CMS officials to discuss quality rating system for managed Medicaid

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.