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2701 - Adult Health Quality Measures

 
Implementation Status 
Statutory Text 

Summary

Amends CHIPRA to require HHS to develop a core set of health care quality measures for Medicaid-eligible adults in the same manner that it currently does for children.  Measures are to be published for public comment by January 1, 2011, followed by the subsequent publication of an initial core set by January 1, 2012.  Requires the development of a standardized format for reporting from the states to HHS by January 1, 2013, as well as reports from HHS to Congress, as specified.  Delineates further requirements regarding annual state reporting of state-specific Medicaid quality measures, with a directive to HHS to publicly disclose such information by September 30, 2014.  Appropriates $60 million for each of FYs 2010-2014 to undertake these efforts.

Last updated: (May 9, 2016)  #Quality, #Transparency

Implementation Status

 
Summary 
Statutory Text 

For the most up-to-date program information generally, including background reports and guidance, see the CMS webpage for this topic (for more historical information about the initial draft set of measures, see here under “Adult Quality Measures”).

Prior to 2013, AHRQ in 2010 published a notice announcing its intent to work collaboratively with CMS to identify and publish an initial core set of measures by the statutory deadlines.  Following several meetings and stakeholder input, in early 2012, HHS published a final notice announcing the initial core set of adult measures.

CMS published an informational bulletin providing more details about the release of the HHS notice.  HHS has also issued grants to states under this provision (e.g., see here and here).  (For more information regarding the latter grant announcement on the Demonstration Grant for Testing Experience and Functional Assessment Tools (TEFT), see here).

On March 27, 2013, CMS issued an informational bulletin in which it pointed to potentially applicable measures under this particular provision of the ACA to pediatric patients under the EPSDT benefit as specifically related to mental health and substance abuse screening.

On May 7, CMS and SAMHSA issued a joint informational bulletin in which the agencies addressed coverage options, including these provisions under the ACA, for children, youth, and young adults with significant mental health conditions.

In August, CMS issued an amendment to an existing Medicaid state demonstration grant opportunity, Testing Experience and Functional Tools in Community-Based Long Term Services and Supports (TEFT), in which CMS seeks to advance adult quality measurement efforts pursuant to section 2701 of the ACA through work conducted under the TEFT.   Applications are due by October 3 (with LOIs having been due on August 19).  This effort, CMS notes, is also consistent with the broader quality improvement goals at section 3011 of the ACA.  More information may be obtained here and here.

In a related event, on June 6, CMS released abulletin discussing plans to administer a nationwide survey of adult Medicaid enrollees’ care access and experience in the fall of 2014 using a modified version of the Adult Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicaid 5.0H questionnaire.

On Nov. 18, MACPAC submitted comments on two recent HHS reports to Congress detailing adult and children’s health care quality efforts, as well as evaluating CHIP (see here and here, respectively). The first of these reports was mandated by this provision of the ACA.

On Dec. 30, CMS released an informational bulletin delineating 2015 updates to the core set of children’s health care quality measures for Medicaid and CHIP (Child Core Set) and to the core set of health care quality measures for adults enrolled in Medicaid (Adult Core Set).  

On May 5, CMS issued a grant titled, “Adult Medicaid Quality: Improving Maternal and Infant Health Outcomes in Medicaid and CHIP.” Under this funding opportunity to which states may apply, CMS seeks to gather data to “improve [CMS’] understanding of the provision of contraceptive services in Medicaid and CHIP populations.” Applications are due July 7.

On Dec. 11, CMS issued an informational bulletin outlining the 2016 updates to the core set of children’s health care quality measures for Medicaid and CHIP (Child Core Set) and the core set of health care quality measures for adults enrolled in Medicaid (Adult Core Set).

On Apr. 25, CMS released an extensive final rule on Medicaid and CHIP managed care (press release; add’l fact sheets available here under “final rule”) that seeks to acknowledge increased enrollment in managed care delivery systems and – to facilitate beneficiaries’ transitions and care management across product lines – promote cross-market alignment with Marketplace Qualified Health Plans (QHPs) and Medicare Advantage (MA). The final rule addresses these provisions of the ACA.

In December 2016, CMS issued an informational bulletin delineating the 2017 updates to the core set of children’s  health care quality  measures for Medicaid  and CHIP (Child  Core Set) and the core set of health care quality  measures for adults enrolled  in Medicaid  (Adult  Core Set).

 

Statutory Text

 
Implementation Status 
Summary 

SEC. 2701. ADULT HEALTH QUALITY MEASURES. Title XI of the Social Security Act (42 U.S.C. 1301 et seq.), as amended by section 401 of the Children’s Health Insurance Program Reauthorization Act of 2009 (Public Law 111–3), is amended by inserting after section 1139A the following new section: ‘‘SEC. 1139B [42 U.S.C. 1320b–9b]. ADULT HEALTH QUALITY MEASURES. ‘‘(a) DEVELOPMENT OF CORE SET OF HEALTH CARE QUALITY MEASURES FOR ADULTS ELIGIBLE FOR BENEFITS UNDER MEDICAID.—The Secretary shall identify and publish a recommended core set of adult health quality measures for Medicaid eligible adults in the same manner as the Secretary identifies and publishes a core set of child health quality measures under section 1139A, including with respect to identifying and publishing existing adult health quality measures that are in use under public and privately sponsored health care coverage arrangements, or that are part of reporting systems that measure both the presence and duration of health insurance coverage over time, that may be applicable to Medicaid eligible adults. ‘‘(b) DEADLINES.— ‘‘(1) RECOMMENDED MEASURES.—Not later than January 1, 2011, the Secretary shall identify and publish for comment a recommended core set of adult health quality measures for Medicaid eligible adults. ‘‘(2) DISSEMINATION.—Not later than January 1, 2012, the Secretary shall publish an initial core set of adult health quality measures that are applicable to Medicaid eligible adults. ‘‘(3) STANDARDIZED REPORTING.—Not later than January 1, 2013, the Secretary, in consultation with States, shall develop a standardized format for reporting information based on the initial core set of adult health quality measures and create procedures to encourage States to use such measures to voluntarily report information regarding the quality of health care for Medicaid eligible adults. ‘‘(4) REPORTS TO CONGRESS.—Not later than January 1, 2014, and every 3 years thereafter, the Secretary shall include in the report to Congress required under section 1139A(a)(6) information similar to the information required under that section with respect to the measures established under this section. ‘‘(5) ESTABLISHMENT OF MEDICAID QUALITY MEASUREMENT PROGRAM.— ‘‘(A) IN GENERAL.—Not later than 12 months after the release of the recommended core set of adult health quality measures under paragraph (1)), the Secretary shall establish a Medicaid Quality Measurement Program in the same manner as the Secretary establishes the pediatric quality measures program under section 1139A(b). The aggregate amount awarded by the Secretary for grants and contracts for the development, testing, and validation of emerging and innovative evidence-based measures under such program shall equal the aggregate amount awarded by the Secretary for grants under section 1139A(b)(4)(A) ‘‘(B) REVISING, STRENGTHENING, AND IMPROVING INI- TIAL CORE MEASURES.—Beginning not later than 24 months after the establishment of the Medicaid Quality Measurement Program, and annually thereafter, the Secretary shall publish recommended changes to the initial core set of adult health quality measures that shall reflect the results of the testing, validation, and consensus process for the development of adult health quality measures. ‘‘(c) CONSTRUCTION.—Nothing in this section shall be construed as supporting the restriction of coverage, under title XIX or XXI or otherwise, to only those services that are evidence-based, or in anyway limiting available services. ‘‘(d) ANNUAL STATE REPORTS REGARDING STATE-SPECIFIC QUALITY OF CARE MEASURES APPLIED UNDER MEDICAID.— ‘‘(1) ANNUAL STATE REPORTS.—Each State with a State plan or waiver approved under title XIX shall annually report (separately or as part of the annual report required under section 1139A(c)), to the Secretary on the— ‘‘(A) State-specific adult health quality measures applied by the State under the such plan, including measures described in subsection (a)(5); and ‘‘(B) State-specific information on the quality of health care furnished to Medicaid eligible adults under such plan, including information collected through external quality reviews of managed care organizations under section 1932 and benchmark plans under section 1937. ‘‘(2) PUBLICATION.—Not later than September 30, 2014, and annually thereafter, the Secretary shall collect, analyze, and make publicly available the information reported by States under paragraph (1). ‘‘(e) APPROPRIATION.—Out of any funds in the Treasury not otherwise appropriated, there is appropriated for each of fiscal years 2010 through 2014, $60,000,000 for the purpose of carrying out this section. Funds appropriated under this subsection shall remain available until expended.’’.

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