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

C. Recommended Activities
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The major tools used to evaluate quality of care, including NCQA's HEDIS. have
limited applicability for children with special health care needs. Short and long term
recommendations for quality improvement initiatives follow.
1. A series of core, integrated quality of care measures related to the care of
children with special health care needs should be developed and submitted to
NCQA's <strong>Committee</strong> on Performance Measurement and to HCFA for the
upcoming revision of the Quality Assurance Reform Initiative.
2. Emerging initiatives for assuring quality of care to children with special health
needs should be evaluated and disseminated as appropriate to states. State Title
V programs must work with their state <strong>Medicaid</strong> agencies to encourage them to
adopt specific contract requirements for quality performance for this population.
3. Multidisciplinary consortia, including pediatric providers and families, should
be formed to design and implement short-term quality improvement studies.
4. Pediatric practice guidelines should be centrally collected, organized, reviewed,
and disseminated. Making these guidelines available to families, through
focused educational efforts, would represent an important quality of care
activity.
5. The example of asthma represents an important measure from which to expand
to other chronic childhood conditions.
6. The role of Title V in monitoring, evaluating, and ensuring compliance in
quality of care in managed care should be expanded. This will require
strengthening the skills and capacity of states in this area and gaining authority
to assume a greater role in quality of care.
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