Medicaid Managed Care - U.S. Senate Special Committee on Aging

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review systems in place to determine whether in fact the quality management
systems have been properly implemented and if they are effective. Medicare, on the
other hand, has had fairly broad and rudimentary requirements but an operational
review process to determine whether a plan's program is functioning effectively.
The following products will be prepared:
Highlights
* a conceptual framework to guide the design and maintenance of an
effective quality monitoring system for Medicare and <strong>Medicaid</strong>;
* joint set of internal quality management program standards for both
programs based on existing federal standards and those used by private
accrediting bodies;
* reviewer guidelines to assist HCFA and state <strong>Medicaid</strong> agencies in
monitoring compliance with proposed standards; and
* an implementation strategy.
* States modify the approaches they use to assure quality of care for all
population enrolled in managed care primarily by developing
measures of plan performance that are more pertinent to the elderly
and persons with disabilities.
* States that use managed care to serve beneficiaries who are members of
special populations may either specifically identify that the needs of
these specific groups must be incorporated into plan quality
assurance/improvement activities or specify that these activities must
address the needs of all groups enrolled in the plan.
* Consumer satisfaction surveys and complaints provide valuable
sources of information to identify potential quality problems.
Particularly in new systems of care that have not been operating long
enough to produce changes in health status or outcomes.
* In order to assess the quality of care provided to dual eligibles <strong>Medicaid</strong>
and Medicare will need to share information about the services each
agency pays for.
The National Academy for State Health Policy * 0 8/97 IV-76