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Quality of Care

Quality care is generally considered to be that which is safe, effective, patient-centered, timely, equitable, and reliable (IOM 2001). At the system level, quality improvement efforts should focus on receipt of the right care, at the right time, in the right setting, all the time (HHS 2011). Ultimately care should be provided that leads to the best outcomes for patients—improvement in health, maintenance of function, and for patients who are in declining health, appropriate and effective care and supportive services that improve quality of life.

Medicaid and CHIP programs engage in quality improvement through delivery system design, payment incentives, and holding plans and providers accountable for desired quality and cost outcomes. States are increasingly incorporating quality measures into their payment and purchasing strategies. They set quality standards in managed care contracts and create incentives for plans to meet targets for improvements in the process and outcome of care, and in the patient experience.

The Centers for Medicare & Medicaid Services (CMS) disseminates findings from state quality reporting in the Medicaid and CHIP Scorecard, and in the annual Child and Adult core set chart pack reports. CMS has also developed quality initiatives and performance measure sets for specific populations and conditions, including behavioral health, maternal and perinatal health, and long-term services and supports (LTSS).

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Featured Publications

Transitions of Coverage and Care for Children and Youth with Special Health Care Needs

March 7, 2024

Medicaid plays a large role in covering health care services for children and youth with special health care needs (CYSHCN). As CYSHCN reach adulthood, they need to transition from child to adult coverage and health care. Research indicates that these young beneficiaries and their families experience barriers during this transition.
This presentation introduced new work on […]

Medicaid Access in Brief: Children and Youth with Special Health Care Needs

March 23, 2023

Almost one in five children and youth have special health care needs, and over one third of these children and youth are covered by Medicaid. In this issue brief, we use data from the 2018 and 2019 National Survey of Children’s Health to examine differences in health status, access to care, referrals, needed care, and […]

Principles for Assessing Medicaid Nursing Facility Payment Policies

March 15, 2023

Chapter 2 examines the transparency of Medicaid payments to nursing facilities. Medicaid is the primary payer for most nursing facility residents, and there is growing concern about the quality of care provided to Medicaid-covered residents. The Commission recommends that the Centers for Medicare & Medicaid Services (CMS) collect and report facility-level data on Medicaid payments to […]