Quality and Consumer Protection in Medicaid

As required by the Affordable Care Act, the Department of Health and Human Services (HHS) published a recommended core set of health quality measures for Medicaid-eligible adults in December 2014. In consultation with states, HHS is also required to develop a standardized format for reporting information based on these measures. They must also create procedures that encourage states to use and voluntarily report on these measures.

In addition, the Affordable Care Act authorized and funded demonstration projects that aim to improve the quality of Medicaid services, including:

  • a demonstration to evaluate integrated financing for care involving a hospital stay by studying the use of bundled payments for hospital and physician services under Medicaid;
  • a Medicaid Global Payment System demonstration conducted with the Center for Medicare & Medicaid Innovation—this demonstration will allow participating states to adjust their payment structure for safety-net hospitals from a fee-for-service model to a global capitated payment structure; and
  • a Medicaid Emergency Psychiatric demonstration, in which participating states will be required to pay certain institutions for services provided to Medicaid beneficiaries age 21–65 who need medical assistance to stabilize an emergency psychiatric condition.