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1) Aug 18 [news release] -- CMS Releases Proposed Rule to Improve Medicaid & CHIP Quality Reporting Across States: Proposed rule details mandatory reporting requirements to standardize Medicaid and CHIP quality measures nationally and promote health equity

The Centers for Medicare & Medicaid Services (CMS) today released a notice of proposed rulemaking to promote consistent use of nationally standardized quality measures in Medicaid and the Children’s Health Insurance Program (CHIP). This will help identify gaps and health disparities among the millions of people enrolled in these programs. This rule proposes requirements for mandatory annual state reporting of three different quality measure sets:

-- the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP;
-- the behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid; and
-- the Core Sets of Health Home Quality Measures for Medicaid.
These Core Sets are designed to measure the overall national quality of care for beneficiaries, monitor performance at the state level, and improve the quality of health care. . . .

Quality measures help evaluate or quantify processes, outcomes, patient perceptions, and even organizational structures associated with providing high-quality health care. The Core Sets include a range of measures key to determining how well Medicaid and CHIP meet their missions of providing affordable, high-quality, person-centered health coverage to low-income people, including children and families. In doing so, the Core Sets can help CMS and partners evaluate Medicaid and CHIP nationally and across the 54 programs run by states and territories. Specifically, the Core Sets will evaluate how Medicaid and CHIP coverage is meeting the needs of individuals and communities, including where health disparities persist, and how the quality of care can be improved.

In addition to the Child and Adult Core Sets, CMS is establishing reporting requirements for states that elect to implement one or both of the optional Medicaid health home benefits under sections 1945 or 1945A of the Social Security Act, which will measure health care quality for states that choose to establish “health homes.” Health homes integrate and coordinate all primary, acute, behavioral health, and long-term services and supports for one of Medicaid’s most at-risk populations: people with significant chronic conditions and/or serious mental health concerns. The Health Home Core Sets will allow CMS to monitor the impact of these optional state plan benefits, thereby improving the quality of health care for the more than 1 million Medicaid beneficiaries with chronic conditions. Currently, 19 states and the District of Columbia have at least one health home program.

While currently voluntary, under this new rule, reporting for the full Child Core Set, behavioral health measures in the Adult Core Set, and the two Medicaid Health Home Core Sets becomes mandatory in federal fiscal year 2024. Data reported in 2024 will reflect care delivered in calendar year 2023. Nationwide reporting of the measure sets will create opportunities to develop a national view of quality in the Medicaid and CHIP programs – a long-sought goal for public health advocates.

Comments on the notice of proposed rulemaking must be submitted to the Federal Register no later than October 21, 2022.

2) Aug 22 -- FRN: Medicaid Program and CHIP; Mandatory Medicaid and Children's Health Insurance Program (CHIP) Core Set Reporting

This proposed rule would establish the requirements for mandatory annual State reporting of the Core Set of Children's Health Care Quality Measures for Medicaid and Children's Health Insurance Program (CHIP), the behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid, and the Core Sets of Health Home Quality Measures for Medicaid. This proposed rule would also establish compliance requirements.

Medicaid was enacted in 1965 as Title XIX of the Social Security Act (the Act) to provide health coverage for certain groups of people with lower incomes. Over the ensuing years, coverage under Medicaid has been extended to additional low-income populations. In addition, in 1997, upon enactment of the Balanced Budget Act of 1997 (Pub. L. 105-33, enacted August 5, 1997), the Children's Health Insurance Program (CHIP) was enacted as Title XXI of the Act. Today, Medicaid and CHIP provide health coverage to approximately 88 million beneficiaries, approximately half of whom are children (40.4 million). Medicaid and CHIP provide health care for some of the most vulnerable Americans, including individuals with very low incomes, pregnant women and children, and people with physical, cognitive, mental, and other disabilities who require long term services and supports (LTSS).

Despite the significant role that Medicaid and CHIP play in America's health care system, this regulation would require—for the first time—States, the District of Columbia (DC) and territories to mandatorily report on measures of the quality of health care provided to Medicaid and CHIP beneficiaries. Until the reauthorization of CHIP in 2009 by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) (Pub. L. 111-3, enacted February 4, 2009), there were no Federal requirements regarding quality measurement to assess the care delivered to beneficiaries. Some quality measurement occurred at the State-level, but there was wide variation in the reliability and completeness of the data, as well as the types of measures reported. Different States focused on different health domains, and significant differences existed in the amount of State resources directed toward quality measurement, the data collection systems and capabilities for measuring quality in each State, and each State's priorities for quality improvement.

Since the establishment of CHIP, participating States have been required to report annually on the operation of their CHIP State plan and progress in reducing the number of uninsured children under section 2108 of the Act. Section 2108 of the Act also requires States to report data about enrollee access to networks of care, such as access to primary and specialty services and care coordination, using quality and satisfaction measures included in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey.

CHIPRA expanded upon these initial requirements. Not only were State reporting requirements for CHIP enhanced, but CHIPRA also required the Federal government to begin monitoring the quality of care and health outcomes for children enrolled in Medicaid and CHIP. Section 401 of CHIPRA added new section 1139A to the Act, which required development of a Core Set of Children's Health Care Quality Measures for Medicaid and CHIP (Child Core Set) which could be voluntarily reported by States. Section 1139A of the Act directed the Secretary to publish for general comment an initial recommended core set of child health quality measures set based on existing quality of care measures for children not later than January 1, 2010.

To assist the Federal Government in establishing priorities for the development and advancement of the Child Core Set, section 1139A of the Act also directed the Secretary to consult with a variety of specific interested parties in developing the initial measures and to work with interested parties annually to update the measures. Following several rounds of review by the initial interested parties and comments from the public, CMS released the initial Child Core Set consisting of 24 measures in 2009, with voluntary State-level reporting to begin in FFY 2010.

The importance of quality reporting was emphasized by Congress again in 2010 when section 2701 of the Affordable Care Act established a new section 1139B of the Act, extending the measurement of health care quality to Medicaid eligible adults. Like the Child Core set, the initial Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set) was designed to reflect the health needs of adults enrolled in Medicaid, with measures capturing cancer screenings and management of chronic conditions. While not required by statute, including separate CHIP enrollees in reporting on the Adult Core Set measures is encouraged; therefore, both Medicaid and CHIP populations are referenced in descriptions of the Adult Core Set (see additional discussion in section II.E. of this proposed rule). The initial Adult Core Set also included five behavioral health measures to capture use of preventive and treatment services for mental health and substance use disorders. CMS issued the initial Adult Core Set consisting of 26 quality measures in 2012, and voluntary reporting of these measures began in FFY 2013.

Congress has continued to advance quality reporting in Medicaid and CHIP by extending the appropriations for Core Sets reporting on a regular basis. The Protecting Access to Medicare Act of 2014 (PAMA), (Pub. L. 113-93, enacted April 1, 2014), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), (Pub. L. 114-10, enacted April 16, 2015) and the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017 (HEALTHY KIDS Act) (Pub. L. 115-120, enacted January 22, 2018) all directed funding to the continued development, submission, and reporting of health care quality measures in Medicaid and CHIP for the Child Core Set.

This regulation would implement mandatory annual reporting of the Child Core Set and the behavioral health measures on the Adult Core Set using a standardized format, as required by section 50102 of the Bipartisan Budget Act of 2018 (Pub. L. 115-123, enacted February 9, 2018) and section 5001 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients (SUPPORT) for Patients and Communities Act (SUPPORT Act), (Pub. L. 115-271, enacted October 24, 2018).

In addition to requiring reporting on the Child Core Set and specified measures on the Adult Core Set, this proposed rule would establish reporting requirements for States that elect to implement one or both of the optional Medicaid health home benefits under sections 1945 or 1945A of the Act.

Implementation of the Child, Adult, and section 1945 Health Home Core Sets represented a major step in the development of a national, evidence-based system for measuring and improving the quality of care delivered to Medicaid and CHIP beneficiaries. The Core Sets include measures that, taken together, may be used to estimate the overall national quality of health care provided to beneficiaries. For instance, through the Child Core Set, data are collected on the percentage of children who receive preventive dental services and through the Adult and section 1945 Health Home Core Sets, data are collected on the number of adult beneficiaries who have their blood pressure under control. The Core Sets also have the potential to assess changes in the quality of and access to health care provided by State Medicaid and CHIP programs over time, and to make comparisons across States and health home programs. For example, the Core Sets capture data on the numbers of child and adult beneficiaries who have been seen by a provider following a hospitalization for mental illness—follow-up care that is critical to improving health outcomes for individuals suffering from mental illness. The ability to assess the quality of and access to care furnished by State Medicaid and CHIP programs is critical given the large number of vulnerable Americans who receive coverage in Medicaid and CHIP and the significant Federal and State resources needed to fund these programs.

FRN proposed rule: https://www.federalregister.gov/d/2022-17810

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