Include care integration in Medicaid core measures
Recommendation
The Centers for Medicare and Medicaid Services (CMS) should provide guidance and technical assistance to states and Managed Care Organizations (MCOs) to help them prepare for congressionally mandated reporting requirements on Medicaid core measurement sets. In future updates of the core set of measures, CMS should ensure the inclusion of measures for behavioral health integration.[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] Beginning in 2024, federal law mandates that states report on two core sets of quality measures: a pediatric set and an adult set.[4][5] Each of these includes behavioral health measures. As these core sets cover a spectrum of specialty and primary care services, core behavioral health measures should include benchmarks for behavioral health integration.[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. Department of Health and Human Services, Centers for Medicare and Medicaid Services. 2023 and 2024 Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP (Child Core Set). (n.d.)
5. Department of Health and Human Services, Centers for Medicare and Medicaid Services. 2023/2024 Core Set of Adult Health Care Quality Measures for Medicaid (Adult Core Set). (n.d.)