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HHS Hazy on Medicaid LTC Quality Measures

By Allison Bell

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Federal regulators are not yet saying much about how new Medicaid health care quality measures might affect people getting Medicaid nursing home benefits and other Medicaid long-term care (LTC) benefits.

The Office of the Secretary at the U.S. Department of Health and Human Services (HHS) has listed the measures in a Medicaid quality measures final notice that is set to appear in the Federal Register Wednesday.

The measures are supposed to give state regulators, federal regulators and others a tool they can use to evaluate the quality of care provided for adults who are eligible for Medicaid.

Section 2701 of the Patient Protection and Affordable Care Act of 2010 (PPACA) required HHS to develop the measures by Jan. 1. State Medicaid programs can use the measures but are not required to do so.

HHS is supposed to develop a standardized reporting format for Medicaid quality measures by Jan. 1, 2013, then start using quality measure data to give Congress Medicaid care quality reports every 3 years. HHS is supposed to publish public reports created using the Medicaid quality measure data starting in 2014.

HHS created the initial core set of quality measures based on recommendations from a subcommittee at the department’s Agency for Healthcare Research and Quality and public comments. The in-house team started with a list of about 1,000 quality measures, came up with a short list of 51 measures for public comment, then received suggestions for 43 additional measures from public commenters.

The team ended up putting 26 measures in the initial core set.

“Although the numbers of measures was reduced, we believe that this initial core set still reflects the health care needs of Medicaid-aid eligible adults,” officials say.

Many of the measures deal with conditions that mainly affect young adults, or with conditions that start when people are young.

One measure, for example, is the percentage of women ages 21 to 24 who have received chlamydia screenings. Another is the percentage of people with HIV infections who have an annual medical visit, and a third deals with the postpartum care rate for women who have just given birth.

Other measures are more relevant to people getting Medicaid LTC benefits.

They include measures for efforts to control high blood pressures, efforts to get transition records transmitted to a patient’s health care professional when the patient is being moved from one setting to another, and efforts to screen patients for conditions such as obesity, breast cancer and cervical cancer.

The quality measure set team cut out a number of proposed measures that excluded individuals with LTC services needs, but none of the measures deals specifically with LTC quality.

“We understand that some of the measures are currently specified only for a particular delivery system (for example, managed care),” officials say. “However, additional guidance will be provided to states so that these measures can be used across delivery systems and Medicaid funded programs targeting adults, including long-term services and supports.”