Happy Friday Program Directors and Policy Committee members!

The Center for Medicaid and Medicare Services are currently accepting comments on proposed projects to develop quality outcome measures for CMS programs serving Medicare-Medicaid enrollees and Medicaid-Only enrollees. Comment submitted to CMS will be used to help CMS and the contractors of the project to solidify specifics about each measure as they move forward with development. In the future these measures may become quality standards our system must meet when serving Medicaid-Only and Medicare-Medicaid  dual enrollees. 

The Medicaid populations the quality measures could impact include:

(1) those eligible for both Medicare and Medicaid, or “dual enrollees”

(2) those receiving long-term services and supports (LTSS) through managed care organizations or through fee-for-service delivery arrangements

(3) people with complex needs and high costs (BCN), substance use disorders, physical and mental health integration needs (PMH).

Each population has one or more measure undergoing the measure development process. 

The measures for each population include:

(1) Those eligible for Medicare and Medicaid

Dual 1: Hospitalization for Ambulatory Care Sensitive Conditions

Duals 3, 4, and 5: Accessing Medical Equipment, Personal Aid Assistance, and Counseling or Treatment-Self-Reported.

HCBS: Admission to an institution from the community among Medicaid fee-for-services Home and Community-Based Services users, including 1915c waiver users.

(2) Those receiving long-term services and supports (LTSS) through managed care organizations or through fee-for-service delivery arrangements:

MLTSS 3: LTSS Share Care Plan

MLTSS 4: Re-assesment and Care Plan Update after Discharge

MLTSS 5: Falls Risk Screening, Assessment, and Plan of Care

MLTSS 6: Admissions to an institution from the Community

MLTSS 7: Successful Discharge to the Community after Short-stays in an Institution

MLTSS 8: Successful Transition to the Community after Long-stays in an Institution 

(3) People with complex needs and high costs (BCN), substance use disorders, physical and mental health integration needs (PMH):

I have attached PDFs for each measure that include a call for public comments with questions about the specifics of each measure, a measure information form, and measure justification form. Please read the PDFs and let the OPRA staff know if you have any comments you would like us to submit. Please submit comments by next Tuesday, the 27th.

Thanks and have a great weekend!

Christine