HR 2843 — Medicaid and CHIP Quality Improvement Act of 2017

Summary

Medicaid and Chip Quality Improvement Act of 2017 This bill amends titles XI (General Provisions) and XIX (Medicaid) of the Social Security Act to expand reporting requirements with respect to the quality of care provided under Medicaid and the Children's Health Insurance Program (CHIP). Current law requires a state that contracts with a Medicaid managed organization to develop and implement a quality assessment and improvement strategy. The bill extends this requirement to state contracts with providers of comparable primary care case management services and other health care services under Medicaid. With respect to adults eligible for Medicaid and children enrolled in Medicaid or CHIP, a state must report annually on quality measures identified by the Centers for Medicare & Medicaid Services (CMS). Such reporting shall be stratified by service delivery system. CMS shall establish a Medicaid Quality Performance Bonus fund to award states for high attainment and improvement on a core set of quality measures. A state must designate at least 75% of any bonus funds for the development and operation of quality-related initiatives that will directly benefit providers or managed care entities participating in, or under a waiver of, the state plan for medical assistance. A state may use the remainder of such funds for activities related to the goals and purposes of the state plan.

Bill Text

• Introduced Introduced in House Current html June 08, 2017

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill establishes new requirements for measuring and reporting healthcare quality in Medicaid and CHIP, introducing both reporting mandates and performance bonuses for states.

• Section 1932(c)(1)(A)

  "or comparable primary care case management services providers described in section 1905(t) as well as health care services furnished in fee-for-service settings or other delivery systems"

  This change expands the quality assurance standards to include more types of service providers.

• Section 1139B

  under the such plan → under such plan or waiver, including measures described in subsection (b)(2), subject to revisions made in accordance with subsection (b)(6)(B)

  This change clarifies the scope of quality reporting requirements for Medicaid.

• Section 1139B

  under section 1937 → section 1937, or comparable primary care case management services providers described in section 1905(t), as well as health care services furnished in fee-for-service settings or other delivery systems

  This amendment includes additional types of providers in the quality measurement and reporting framework.

• Section 1139B

  including analysis of comparable quality measures for Medicaid eligible adults who receive their health services through managed care, primary care case management, and fee-for-service settings or other delivery systems

  This establishes a requirement for a more detailed analysis in reporting quality measures.

• Section 1139A

  Reporting of pediatric health care measures.-- Beginning not later than January 1 of the calendar year that begins on or after the date of enactment of the Medicaid and CHIP Quality Improvement Act of 2017, and annually thereafter, the Secretary shall require States to use the measures and approaches identified in paragraph (4) to report on the initial core child health care quality measures established under this subsection and as such measures subsequently are updated under subsection (b)(5). Such reporting shall be stratified by delivery system, including managed care organizations under section 1932, benchmark plans under sections 1937 and 2103, primary care case management services providers described in section 1905(t), health care services in fee-for-service settings, and other delivery systems, except that the Secretary may determine that reporting on certain measures should not be stratified by delivery system because such stratification would not be feasible or the delivery systems are not comparable with respect to the application of such measures. In addition to the stratification required under the previous sentence, the Secretary shall have the discretion to further stratify reporting on certain measures based on factors such as eligibility category, income level, or other differentiating factors that could have an impact on the comparability of the measure.

  This requires states to report on pediatric health care quality measures and allows for stratification of data.

• Section 1903

  Performance Bonus for Quality Performance Achievement.-- The Secretary shall establish a Medicaid Quality Performance Bonus fund for awarding performance bonuses to States for high attainment and improvement on a core set of quality measures related to the goals and purposes of the Medicaid program under this title.

  This introduces a performance bonus system to incentivize states for quality improvements.

Action History

1. June 09, 2017

   Referred to the Subcommittee on Health.

2. June 08, 2017

   Introduced in House

3. June 08, 2017

   Introduced in House

4. June 08, 2017

   Referred to the House Committee on Energy and Commerce.

Sponsors

• Diana DeGette · Primary

Subjects