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Quality and Health Improvement Reports

Medicaid Quality Strategy

Requirements as outlined under Code of Federal Regulation 42 CFR 438.200 - 204 delineate State responsibilities for adoption of a Quality Strategy. 42 CFR 438.202(a) states that States will have a written strategy for assessing and improving the quality of managed care services offered by all Managed Care Organizations (MCOs) and Prepaid Inpatient Health Plans (PIHPs).

Reports

  • HEDIS: Standardized performance measures designed to ensure that purchasers and consumers have the information they need to reliably compare the performance of managed health care plans.
  • Performance Improvement Projects (PIPs)Improvement projects completed by the Department's contracted health plans
  • Client Satisfaction Surveys (CAHPS)Standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care.
  • Performance Measure and Encounter Data Validation: Behavioral Health Organization Performance Measure Validation are annual validation activities outlined in the CMS protocol. Encounter Data Validation evaluates the accuracy and completion of administrative encounters for behavioral health services.
  • Annual Technical Reports: Annual Technical Reports and Legislative Reports on Status of Pediatric Health Care Quality Performance Measures
  • Site Reviews/AuditsSite Reviews are performed on-site at the MCO/PIHP health care delivery system sites to assess the physical resources and operational practices in place to deliver health care.
  • Experience of Care and Health Outcomes (ECHO) Surveys: Satisfaction surveys for clients who have received behavioral Health care services.

412 Audit

2024 RAE 412 Audits: Encounter Data Validation

2023 RAE 412 Audits: Encounter Data Validation

2022 RAE 412 Audits: Encounter Data Validation

2021 RAE 412 Audits: Encounter Data Validation

2020 RAE 412 Audits: Encounter Data Validation

411 Audit

2024 RAE 411 Audits: Encounter Data Validation

2023 RAE 411 Audits: Encounter Data Validation

2022 RAE 411 Audits: Encounter Data Validation

2021 RAE 411 Audits: Encounter Data Validation

2020 RAE 411 Audits: Encounter Data Validation

Financial Template Review

Quality of Care Grievance Reports

Network Adequacy Validation Reports