pa-56-42-1523: Medical Assistance and Children's Health Insurance Program managed care quality strategy for the Commonwealth

Summary

The Department of Human Services (Department) is making available for public review and comment the Medical Assistance (MA) and Children's Health Insurance Program (CHIP) Managed Care Quality Strategy for the Commonwealth. Background The Centers for Medicare & Medicaid Services (CMS) requires states to draft and implement a written quality strategy for assessing and improving the quality of health care and services furnished by managed care organizations (MCO) that have an agreement with the Department (see 42 CFR 438.340(a) and 457.1240(e) (relating to managed care State quality strategy; and quality measurement and improvement)). As a result, the Department has developed the MA and CHIP Managed Care Quality Strategy (MCQS), which discusses the various initiatives the Department has implemented to improve the quality of care for individuals receiving services through its managed care programs. The MCQS for the Commonwealth is not intended to comprehensively describe all the activities the Department undertakes to assure the quality of care rendered to individuals who are receiving services through its managed care programs. The MCQS is an updated version of the previous quality strategy submitted to CMS in December 2023, and describes initiatives, strategies and processes to improve, evaluate and monitor member access to high quality, timely and preventive care through the Medicaid and CHIP managed care delivery system. Discussion As the delivery system landscape...

The agency’s own summary, as published.