department of health and social services

Division of Medicaid and Medical Assistance

Statutory Authority: 31 Delaware Code, Section 512 (31 Del.C., §512)

PROPOSED

PUBLIC NOTICE

Delaware Medicaid and CHIP Managed Care Quality Assessment & Improvement Strategy Draft

In compliance with the State's Administrative Procedures Act (APA - Title 29, Chapter 101 of the Delaware Code) and under the authority of Title 31 of the Delaware Code, Chapter 5, Section 512, Delaware Health and Social Services (DHSS) / Division of Medicaid and Medical Assistance (DMMA) is announcing a thirty (30)-day public comment period on its draft of the State’s Draft Quality Strategy for healthcare services.

Any person who wishes to make written suggestions, compilations of data, testimony, briefs or other written materials concerning the proposed new regulations must submit same to Sharon L. Summers, Planning & Policy Development Unit, Division of Medicaid and Medical Assistance, 1901 North DuPont Highway, P.O. Box 906, New Castle, Delaware 19720-0906 or by fax to 302-255-4425 by November 30, 2010.

The action concerning the determination of whether to adopt the proposed regulation will be based upon the results of Department and Division staff analysis and the consideration of the comments and written materials filed by other interested persons.

SUMMARY OF PROPOSAL

The proposal announces a thirty (30)-day public comment period on the draft of the Delaware Medicaid and CHIP Managed Care Quality Assessment and Improvement Strategy for healthcare services.

Statutory Authority

Section 1932(c)(1) of the Social Security Act, Quality Assurance Standards, Quality Assessment and Improvement Strategy

42 CFR 438, Subpart D, Quality Assessment and Performance Improvement

Background

The Delaware Medical Assistance Program (DMAP) is required to develop a Medicaid Managed Care Quality Assessment and Improvement Strategy (Strategy), pursuant to 42 CFR §438.200. A separate strategy has been developed for the Managed Care Organizations (MCOs).

The DMAP Managed Care Quality Assessment and Improvement Strategy incorporates policies; procedures; contract compliance; and input from the public, stakeholder providers, recipient advocates and multiple state agencies that hold an interest in the improvement of access and of clinical and service quality received by the Medicaid recipients.

All quality activities for the DMAP population are integrated into a single Strategy, which applies throughout the Delaware Medicaid Managed Care service area. The Division of Medicaid and Medical Assistance (DMMA) oversees the Strategy to verify that the performance of quality improvement functions is timely, consistent, and effective.

The Strategy is designed with the intent that services provided to recipients meet established standards for access to care; clinical quality of care and quality of service, and that opportunities to improve these areas are identified and acted upon. The Strategy is designed to identify, document, and review access, quality of care, and service issues, and to verify that appropriate corrective actions are taken to address these issues.

The Strategy features:

• Assessment and improvement of quality of care and services through use of monitoring and national benchmarks for the Medicaid population

• Focused audits

• Studies

• Assessment of recipient and provider satisfaction

• Review of potential quality issues, recipient appeals and grievances

• Review of access to care through analysis of provider networks using contract and credentialing criteria

• Compliance with contractual operations and organizational structure.

Following the public notice, the proposed Quality Strategy will be submitted to the Centers for Medicare and Medicaid Services (CMS) for approval no later than December 3, 2010. The finalized Quality Strategy will become effective on December 6, 2010 with the execution of the new Memorandum of Agreement and will be reviewed by the state quarterly, as a standing agenda item, during regularly scheduled Quality Improvement Initiative (QII) Task Force meetings and teleconferences. The State, in turn, will provide quarterly updates to CMS with regard to the status of the State’s Quality Strategy for DMAP and will provide CMS with written revisions to the Quality Strategy whenever significant revisions are made to the Strategy. A copy of the annual Work Plan will be submitted to CMS each year.

The program is reviewed, evaluated and updated annually or more often as additional information becomes available.

Summary of Proposal

DMMA is announcing a thirty (30)-day public comment period on the draft State Quality Strategy. The strategy is designed to monitor and evaluate the quality and appropriateness of healthcare services to enrollees the Delaware Medicaid and CHIP programs.

The specific goals of the Quality Strategy are to:

• Enhance efficiency of care;

• Increase effectiveness of care;

• Promote equity of care;

• Enrich patient-centeredness;

• Ensure safety; and,

• Improve timeliness of care.

Fiscal Impact Statement

These revisions impose no increase in cost on the General Fund.

*Please Note: Due to the size of the proposed regulation, it is not being published here. A PDF version of the regulation is available at:

Delaware Medicaid and CHIP Managed Care Quality Assessment & Improvement Strategy Draft

14 DE Reg. 361 (11/01/10) (Prop.)