Background
Measuring and improving the quality of health care received is one of the highest priorities of the U.S. health care system. In Medicaid, Federal law already requires various quality monitoring and improvement processes for capitated managed care organizations. However, for the majority of Medicaid enrollees, who are served by Primary Care Case Management (PCCM) or fee-for-service arrangements, including many of those with the most severe health needs, there are no federal requirements for comparable quality monitoring or measuring improvement. Additionally, no structured oversight exists for Medicaid enrollees when they move between fee-for-service and capitated managed care plans.
ACAP Position and Legislative Action
ACAP is actively working with members of Congress and many interested partners to introduce legislation that would strengthen comparable quality monitoring procedures and allow for measurement of improvement over time. ACAP has developed a proposal called the Medicaid Continuous Quality Act (MCQA) which would direct the Secretary of Health and Human Services to develop procedures to ensure that quality monitoring is conducted in Medicaid PCCM and fee-for-service arrangements, just as it is now for Medicaid managed care, in order to make fair assessments across all modes of care. By making policies to measure quality of care in Medicaid more comprehensive, it will ultimately help federal and state administrators improve the quality of services delivered in Medicaid and improve the value of care received.
ACAP is working on a parallel track to strengthen quality reporting and measurement procedures and policies through several other vehicles. For example, ACAP regularly submits comments on Federal quality-related regulations, as appropriate, and helps to inform and influence the work of other quality-focused organizations.
ACAP Documents Relating to Quality
ACAP Quality Comments on Regulations