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CMS releases scorecard to promote transparency within Medicaid and CHIP program

This is the first time state comparisons can be made on quality health measures.

Susan Morse, Senior Editor

The Centers for Medicare and Medicaid Services launched its first scorecard on individual state health system performance in the Medicaid and Children's Health Insurance Program.

The Medicaid and CHIP scorecard rates health measures such as immunizations, well-child visits, treatment for beneficiaries diagnosed with substance-abuse problems, blood pressure control,  follow up care after hospitalizations for mental illness, prenatal and postpartum care, chronic health conditions and dental services.

The scorecard also shows the timeliness of state and federal approvals for managed care capitation rate reviews, demonstration waivers and state plan amendments.

"Despite providing health coverage to more than 75 million Americans at a taxpayer cost of more than $558 billion a year, we have lacked transparency in the performance and outcomes of this critical program," said CMS Administrator Seema Verma. "The scorecard will be used to track and display progress being made throughout and across the Medicaid and CHIP programs, so others can learn from the successes of high performing states."

The first version of the scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas: state health system performance, state administrative accountability, and federal administrative accountability.

In future years, the scorecard will include opioid-related metrics and home and community based services, as well as the ability to compare spending patterns, CMS said.

However, the National Association of Medicaid Directors took issue with the reporting measures' comparability, accuracy and timeliness, since the most current data is from 2015. 

Comparisons are being made across states that have significantly different structures and care delivery approaches, the NAMD said.

In some cases, the data reflects fee-for-service or managed care but not necessarily the beneficiaries in both delivery models, resulting in healthy populations being compared to those with disabilities or complex conditions, the NAMD said. 

Also, some states use claims-based reporting while others use a hybrid methodology of a claims and medical record review. Until this and other differences are resolved, there be no apples to apples comparison, the group said.

Margaret Murray, CEO of the Association for Community Affiliated Plans, said while she recognized inconsistencies, this was a good start.

"For one thing, the draft scorecard brings into sharp relief the need for more uniform, consistent data reporting across the Medicaid program," Murray said. "ACAP has consistently advocated for mandatory reporting on a core set of pediatric and adult quality measures allowing for comparisons between managed care, fee-for-service, and other Medicaid delivery systems."

Verma said the scorecard falls in line with President Trump's commitment to "cut the red tape" by aligning existing reporting requirements with other data sets.

Medicaid covers over 35 million children, paying for approximately 50 percent of the country's births, and is the single largest payer for long-term care services for the elderly and people with disabilities.

In 1985, Medicaid consumed 10 percent of state budgets. In 2016 that number rose to 30 percent.

Twitter: @SusanJMorse
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