Quality and Consumer Protection in Medicaid

On this page: 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 Medicaid-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 ACA Comprehensive health care reform legislation passed by Congress and signed into law on March 23, 2010. 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 An office within the Centers for Medicare & Medicaid Services (CMS) that is 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 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.

QUALITY AND CONSUMER PROTECTION IN MEDICAID: Policy

General

In this policy: FederalState

Federal and state efforts to restructure Medicaid should ensure that:

  • Long-term services and supports Also known as Long-term Care (LTC), LTSS encompass a broad range of assistance needed by people of all ages who have cognitive or mental impairments and who may lack the physical ability to function independently.  In their basic form, LTSS consist of help with self-care and… 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 this policy: FederalState

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

In this policy: Federal

Congress should require Medicaid and Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… program administrators to collaborate to ensure that Medicaid disease management programs continue to function effectively for Medicaid beneficiaries receiving Medicare Authorized in 1965 under Title XVIII of the Social Security Act, Medicare provides health insurance coverage for people age 65 and older and for some disabled people under age 65. This federal program consists of Part A (Hospital Insurance), Part B (Supplemental Medical Insurance), Part… prescription drug coverage. Both programs should be required to evaluate their impact on health outcomes and should ensure the protection of beneficiaries’ privacy rights.