Enhance quality metrics for Medicaid managed care
Recommendation
The Medicaid Managed Care Quality Rating System should include measures of behavioral health integration and states should set a minimum rating for Managed Care Organizations (MCOs) on performance measures.[1]
Background/summary
Current regulations require the Centers for Medicare and Medicaid Services (CMS) to develop a Medicaid Managed Care Quality Rating System in consultation with states and other stakeholders.[2][3] Under these regulations, CMS is responsible for identifying key performance indicators, including a subset of mandatory performance indicators, and providing guidance to states regarding these or their own proprietary quality measurement programs.[1] States may opt to implement additional criteria but must at least include the subset of mandatory measures.[1] CMS has developed a set of behavioral health measures which primarily cover screening for mental health concerns and adherence to medication protocols.[4] While measurement is a vital step to ensure MCO care quality is upheld, measurement alone is insufficient without minimum performance thresholds.[1] CMS should include more robust measures regarding behavioral health integration and provide guidance to states to set a minimum rating for MCOs on performance measures.[1]
citations
1. Bipartisan Policy Center. Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration (Task Force Recommendations). Last Updated March 2021.
2. Federal Register. Medicaid and Children's Health Insurance Program (CHIP) Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions Related to Third Party Liability. Last Updated May 6, 2016.
3. Federal Register. Medicaid Program; Medicaid and Children's Health Insurance Program (CHIP) Managed Care. Last Updated November 13, 2020.
4. Medicaid.gov. 2023-24 Core Set of Behavioral Health Measures for Medicaid and CHIP (Behavioral Health Core Set). (n.d.)