CMS Proposes Reporting Requirement for Medicaid, CHIP Quality Measures

CMS has released a proposed rule that aims to establish reporting requirements and standardize quality measures across Medicaid and the Children’s Health Insurance Program (CHIP) to help identify care disparities.

The Mandatory Medicaid and CHIP Core Set Reporting proposed rule includes requirements for states to report three quality measure sets that assess the overall national quality of care for Medicaid and CHIP beneficiaries.

“The Medicaid and CHIP Core Sets of quality measures for children, adults, and health home services are key to promoting health equity. They will allow us not only to identify health disparities but also to implement interventions based on the very data that make those disparities clear,” CMS Administrator Chiquita Brooks-LaSure said in a press release.

“CMS will use every lever available to ensure a high quality of care for everyone with Medicaid and CHIP coverage. By requiring states to report the core sets of quality measures, we can ensure that our policies are supported by data representing all of our beneficiaries.”

The first set of quality measures focuses on children’s healthcare quality and applies to Medicaid and CHIP. The second set includes behavioral health quality measures for adults.

These core sets will evaluate if Medicaid and CHIP are succeeding in providing affordable, high-quality, person-centered healthcare coverage to low-income people. In addition, the measures aim to identify communities where care disparities are common and determine how Medicaid and CHIP can improve care quality.

The third quality measure set focuses on Medicaid’s health home benefits. States can choose to implement Medicaid’s optional health home benefits under sections 1945 and 1945A of the Social Security Act.

Health home benefits provide coordinated care to Medicaid beneficiaries with chronic conditions or severe mental health concerns. The model integrates primary, acute, behavioral health, and long-term services and supports for more than 1 million beneficiaries across 19 states and Washington DC.

The reporting requirement will measure healthcare quality for states that elect to implement health home benefits and allow CMS to assess how the optional benefits impact care for Medicaid beneficiaries.

Reporting for the three quality measure sets is currently voluntary under the proposed rule but will be mandatory for states starting in fiscal year 2024. The data reported in 2024 will reflect care delivered in calendar year 2023, CMS noted.

In addition to the proposed rule, HHS and CMS released guidance promoting mental healthcare coverage for children.

In the first informational bulletin, “Leveraging Medicaid, CHIP, and Other Federal Programs in the Delivery of Behavioral Health Services for Children and Youth,” CMS reminded states of their responsibility to cover mental and behavioral healthcare services for children enrolled in Medicaid.

The document includes strategies states can utilize to improve prevention, early identification, and treatment of behavioral health concerns. In addition, the guidance offers strategies to expand provider capacity and increase the integration of behavioral health and primary care.

The second informational bulletin, “School-based Health Services in Medicaid: Funding, Documentation, and Expanding Services,” encourages states to work with schools to provide on-site healthcare services to children enrolled in Medicaid. This guidance aims to expand the availability of school-based mental healthcare services, health screenings, immunizations, and substance use disorder treatment.

“As we begin the school year, a top priority of the Biden Administration is to ensure all children have access to the full range of care and support they need to stay healthy and thrive – including mental health services,” HHS Secretary Xavier Becerra, said in the press release. 

“For the millions of children who are covered by Medicaid and CHIP, this means working with states to ensure they are pulling every lever to strengthen and expand comprehensive access to mental healthcare for children.”