HHS Resources Address Oversight of Medicaid, CHIP Quality of Care

The US Department of Health and Human Services (HHS) released new resources through CMS, aiming to improve the quality of care that Medicaid and the Children’s Health Insurance Program (CHIP) provide.

CMS and HHS offered the new resources in a Center for Medicaid and CHIP Services Informational Bulletin (CIB). The suite includes tools and templates related to state oversight of Medicaid and CHIP managed care organizations.

“Today we are taking action to strengthen the oversight and transparency of Medicaid and CHIP-managed care programs,” said HHS Secretary Xavier Becerra. “We are working hand-in-hand with states and doubling down on our efforts to improve access to health care for the millions of Americans enrolled in these programs.”

As part of the suite of tools, the department launched updates to an online portal that aids states in the reporting process.

Additionally, the tool offers targeted support to Indian Health Care Providers, addressing themes such as enforcing timely payment and navigating regulations for managed care organizations that serve Alaska Natives and American Indians.

CMS reinforced the requirement that states submit Network Adequacy and Access Assurances reports. The agency will share the results of its network adequacy review on the Medicaid website but did not reveal in this press release the specific date when that web page would go live. Until then, states can request copies of the reviews if needed.

CMS also standardized the reporting process for medical loss ratios and network adequacy. The agency offered a template for each reporting process to help create transparency and facilitate comprehensive reporting.

Also, to assist Medicaid enrollees who are involved in managed long-term services and supports (MLTSS), CMS offered a toolkit that helps in the process of moving beneficiaries from institutions to home-based settings. 

These supports may serve to alleviate concerns about oversight of Medicaid managed care organizations. Shortly before HHS released these resources, a report from the US Government Accountability Office (GAO) found gaps in CMS oversight of the direct payment process in Medicaid managed care.

“The tools we’re releasing today reflect the latest—and certainly not the last—step CMS is taking to increase transparency and ensure that people served through Medicaid and CHIP managed care programs are receiving high-quality, high-value care,” said CMS Administrator Chiquita Brooks-LaSure.

Outside of Medicaid managed care, HHS took steps to improve access to care and quality of care in other areas of the healthcare industry leading up to the announcement about managed care resources.

In May 2022, HHS provided the Title X family planning program with $16.3 million to assist the efforts of improving telehealth services. Containing locations across the country, the Title X family planning clinics intended to improve access to care, which included the availability of virtual resources.

In June 2022, HHS provided a grant totaling $115 million to 60 organizations, all of whom aimed to improve access to HIV care. The goals of the organizations were not only to treat those suffering from HIV but also to end the epidemic.

Also in June 2022, HHS worked with the Healthcare Resources and Services Administration (HRSA) to create a program aiming to improve access to primary care.