NOTICES
DEPARTMENT OF
HUMAN SERVICES
Medical Assistance Quality Strategy for Pennsylvania
[47 Pa.B. 2835]
[Saturday, May 13, 2017]The Department of Human Services (Department) is making available for public review and comment the Medical Assistance Quality Strategy for Pennsylvania.
Background
The Centers for Medicare and Medicaid Services (CMS) requires states to draft and implement a written quality strategy for assessing and improving the quality of health care and services furnished by managed care organizations that have a contract with the Department (see 42 CFR 438.340 (relating to managed care State quality strategy)). As a result, the Department has developed the Medical Assistance Quality Strategy for Pennsylvania, which discusses the various quality improvement initiatives the Department has implemented to increase the quality of care for individuals receiving services through its managed care programs. The Medical Assistance Quality Strategy for Pennsylvania is not intended to comprehensively describe all the activities that the Department undertakes to assure the quality of care rendered to individuals who are receiving services through managed care programs.
The Department is required by 42 CFR 438.340(c)(2) to update its managed care quality strategy as needed. The Department has eliminated all references to the Healthy Pennsylvania demonstration from the Medical Assistance Quality Strategy for Pennsylvania because it was terminated on September 30, 2015. In addition, the Department has added quality initiatives for the Children's Health Insurance Program (CHIP) and the Office of Long-Term Living's Community HealthChoices Program to the Medical Assistance Quality Strategy for Pennsylvania.
References in the Medical Assistance Quality Strategy for Pennsylvania are to the prior version of the Medicaid managed care regulations. States are not required to comply with the current regulations on the managed care final rule until July 1, 2018, and will not be held to be out of compliance with the current version of the Medicaid managed care regulations as long as the state is complying with the prior version of the regulations. (See 81 FR 27498, 27499 (May 6, 2016).)
Discussion
The Department's quality strategy will be used to assure that the contractors that are implementing the Department's managed care programs are in compliance with the terms of their agreements with the Department and have committed resources to meet the following: to perform monitoring and ongoing quality improvement; to contribute to the improvement of health for the populations they serve; and to incorporate new programmatic changes to assure that the individuals they serve have timely access to high-quality care.
The Office of Medical Assistance Programs, Bureau of Managed Care Operations' key initiatives are centered around value-based purchasing, and include reducing preventable hospital admissions and readmissions, increasing preventive dental services for children, improving coordination and integration between physical health and behavioral health managed care programs, rewarding managed care organizations and providers through the use of pay for performance programs and encouraging expanded use of community-based care management teams.
The Office of Mental Health and Substance Abuse Services' key quality improvement initiatives include implementation of telepsychiatry services, use of mobile mental health treatment services for individuals who are not mobile, expanding mental health and substance use screening strategies within Person-Centered Medical Homes (PCMH), and establishing PCMH options for individuals with serious mental illness and substance use disorders.
The Office of Long-Term Living will be implementing Community HealthChoices, a Statewide mandatory managed care program. Eligible individuals include: (i) adults that are eligible for Medical Assistance and need long-term services and supports; and (ii) individuals who are dually eligible for Medical Assistance and Medicare. This initiative is intended to improve care coordination, service delivery and quality outcomes for seniors and individuals living with physical disabilities in this Commonwealth.
CHIP will be making changes in its policies and procedures to comply with the CMS Managed Care Final Rule published at 81 FR 27498. These changes will allow CHIP to align more with the procedures and resources of Medical Assistance, while also allowing individuals to easily transition between the CHIP and Medical Assistance Programs.
Finally, key quality initiatives for the Adult Community Autism Program (ACAP) include increasing the number of community-based services available for individuals who receive services through ACAP, improving coordination across multiple systems that provide support for adults with autism and improving the service delivery system to address the diversity of needs of individuals who are diagnosed with autism.
The Medical Assistance Quality Strategy for Pennsylvania can be viewed at http://www.healthchoicespa.com/.
Public Comment
Interested persons are invited to submit comments regarding the Medical Assistance Quality Strategy for Pennsylvania to the Department at RA-PWQualityStrategy@pa.gov. Comments received within 30 days must be reviewed and considered before the Quality Strategy is submitted to CMS for review (see 42 CFR 438.340(c)(1)).
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania AT&T Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
THEODORE DALLAS,
SecretaryFiscal Note: 14-NOT-1134. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 17-828. Filed for public inspection May 12, 2017, 9:00 a.m.]
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