Quality and Consumer Protection in Medicaid

Background

The Affordable Care Act requires the Department of Health and Human Services (HHS) to publish a recommended core set of health quality measures for MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. -eligible adults. These measures were published in December 2014. HHS, in consultation with states, is also required to develop a standardized format for reporting information based on these measures, and to 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 MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. 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 MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. ;
  • a MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Global Payment System Demonstration conducted with the Center for Medicare & Medicaid InnovationAn office within the Centers for Medicare & Medicaid Services (CMS) charged with testing payment and service delivery models that reduce spending while enhancing the quality of care in Medicare and Medicaid. —this demonstration will allow participating states to adjust their payment structure for safety-net hospitals from a Fees-for-Services model to a global capitated payment structure; and
  • a MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. Emergency Psychiatric Demonstration, in which participating states will be required to pay certain institutions for services provided to MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. beneficiaries age 21–65 who need medical assistance to stabilize an emergency psychiatric condition.

QUALITY AND CONSUMER PROTECTION IN MEDICAID: Policy

QUALITY AND CONSUMER PROTECTION IN MEDICAID: Policy

General

Federal and state efforts to restructure MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. should ensure that:

  • Long-term services and supportsLTSS encompasses a broad range of assistance with activities of daily living and health-related tasks for people with functional limitations caused by physical or mental impairments. LTSS may be delivered in institutions or in a person’s home or a residential care setting. reflect the needs and preferences of beneficiaries and their families and provide a choice between home- and community-based support services and nursing facilities services;
  • quality protections are given the same priority as cost and access issues; and
  • consumers have a strong voice.

Fraud and abuse

In addressing fraud, waste, and abuse, federal and state governments should identify and implement strategies that do not threaten access to program benefits for people with low incomes and that direct savings back into the program.

Disease management programs and Medicare Part D

Congress should require MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. and MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). program administrators to collaborate to ensure that MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. disease management programs continue to function effectively for MedicaidA joint federal/state program that provides health care and LTSS. However, to qualify for Medicaid LTSS, people must have extremely low assets and income, or they have to “spend down” most of their assets. beneficiaries receiving MedicareMedicare is the federal health insurance program for people who are age 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD), (permanent kidney failure requiring dialysis or a transplant). prescription drug coverage. Both programs should be required to evaluate their impact on health outcomes and should ensure the protection of beneficiaries’ privacy rights.