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Quality of Care

 

Medicaid and the Children’s Health Insurance Program (CHIP) seek to provide safe, effective, efficient, patient-centered, high quality and equitable care to all enrollees.  To achieve these goals, the Centers for Medicare and Medicaid Services (CMS) partners with states to share best practices and to provide technical assistance to improve the quality of care.

Quality Initiatives

CMS has initiatives to improve the quality of care provided to Medicaid and CHIP enrollees in the following areas:

EPSDT
Dental Care
Obesity
Maternal and Infant Health
Home and Community-Based Services
Vaccines
Prevention
Health Disparities
Performance Measurement
Patient Safety
External Quality Review
External Quality Review Technical Reports
State Quality Strategies
Annual CMS Medicaid/CHIP Quality Conference
Improving Care Transitions
TEFT

National Quality Strategy

The National Quality Strategy, required by The Affordable Care Act of 2010, is a national plan to improve the delivery of health care services, patient health outcomes, and population health.

Three goals are used to guide and assess local, state, and national efforts to improve health and the health care delivery system:

  1. Better Care
  2. Healthy People/Healthy Communities
  3. Affordable Care

See the National Quality Strategy March 2011 Report to Congress.    

Events & Announcements

Maternal and Infant Health Initiative

Building upon a yearlong series of discussions with stakeholders, CMCS announces a new initiative to improve maternal and infant health.  The initiative is a four pronged strategy designed to: 1) improve the rate and content of postpartum visits; and 2) increase use of most and moderately effective methods of contraception among Medicaid and CHIP beneficiaries.  See the Maternal and Infant Health Initiative

For more information on CMCS quality improvement activities in maternal and infant health, see Maternal and Infant Health Care Quality

Resources to Improve Medicaid for Children and Adolescents

CMS, in partnership with NASHP, developed a resource page for state policymakers, Medicaid officials, and other interested parties with state-specific information about strategies for delivering the Medicaid benefit for children and adolescents, (also known EPSDT).  Use this resource page to access information from state Medicaid agencies on a variety of topics including: 

  • General and specific definitions of medical necessity used by states
  • Initiatives to improve access to preventive and treatment services for children
  • Reporting and data collection strategies around children's services
  • Approaches to behavioral health screening and service delivery
  • Resources developed to support providers and families
  • Initiatives to improve care coordination for children
  • Oral health service delivery for children

New Releases

CMS Efforts to Ensure Children Receive Developmental and Behavioral Screening
CMS supports states to improve the delivery of developmental and behavioral screening to young children enrolled in Medicaid and CHIP, and the tracking and reporting of these screenings through the Child Core Set measure (See June 2013 CMS Developmental Screening Webinar and CMS Fact Sheet on Developmental and Behavioral Screening of Young Children). Birth to 5: Watch Me Thrive!, a joint effort between the Department of Health and Human Services and the Department of Education, provides additional resources to support states, providers and communities to increase developmental and behavioral screening of young children.

Efforts to Improve Children’s Health Care Quality in Medicaid and CHIP (2014 Report to Congress)

Efforts to Improve the Quality of Health Care for Adults in Medicaid (2014 Report to Congress)

Preventive and Obesity-Related Services Available to Medicaid Enrollees (2014 Report to Congress)

Improving Oral Health Care Delivery in Medicaid and CHIP: A Toolkit for States