CHA News Article

CMS Reports on Quality of Care for Children, Adults Enrolled in Medicaid

Recently, the Centers for Medicare & Medicaid Services (CMS) published a pair of reports on the quality of care received by adults enrolled in Medicaid and children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP summarizes state-specific information on the quality of health care furnished to children covered by Medicaid and CHIP. The 2015 Annual Report on the Quality of Care for Adults in Medicaid summarizes information on the quality of health care furnished to adults covered by Medicaid.

According to the 2015 Annual Report on the Quality of Care for Children in Medicaid and CHIP, Medicaid and CHIP served more than 43 million children in federal fiscal year (FFY) 2014, representing more than one in three U.S. children. CMS conducted detailed analysis of state performance on child core set measures reported by at least 25 states. The quality report addresses levels of primary care visits, prenatal care, chronic disease management, behavioral health trends and dental care, as well as findings from managed care external quality reviews and performance improvement projects. The report shows the continued progress made by the U.S. Health and Human Services Agency (HHS) and states in building a national, cross-state quality measurement and reporting system for children’s health care in Medicaid and CHIP.

The 2015 Annual Report on the Quality of Care for Adults in Medicaid includes for the first time findings on the core set of health care quality measures for adults enrolled in Medicaid (referred to as the adult core set). In FFY 2014, Medicaid covered a total of 44.3 million adults, including 27.1 million non-elderly adults, 6.3 million adults age 65 and over and 10.9 million individuals who are blind/disabled. The Affordable Care Act required the HHS Secretary to establish an adult health care quality measurement program to standardize the measurement of health care quality across state Medicaid programs and facilitate the use of the measures for quality improvement. The 2015 report presents findings on voluntary state reporting of the adult core set measures for FFY 2014, and summarizes information on managed care quality measurement and improvement reported in the external quality review technical reports submitted to CMS by states during the 2014-155 reporting cycle. CMS conducted detailed analysis of state performance on 10 frequently reported measures, with the results presented in four domain-specific reports: 1) primary care access and preventive care, 2) perinatal health, 3) care of acute and chronic conditions, and 4) behavioral health care.

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