Page 31

Section 7. Quality and Appropriateness of Care

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 8.

7.1. Describe the methods (including external and internal monitoring) used to assure the quality and appropriateness of care, particularly with respect to well-baby care, well- child care, and immunizations provided under the plan. (2102(a)(7)(A)) (42CFR 457.495(a))

Will the state utilize any of the following tools to assure quality? (Check all that apply and describe the activities for any categories utilized.) 7.1.1.

Quality standards 7.1.2.

Performance measurement 7.1.3.

Information strategies 7.1.4.

Quality improvement strategies

KCHIP will use quality standards, performance measures, information, and quality improvement strategies to assure high-quality care for KCHIP enrollees. KCHIP will be incorporated into Kentucky's Health Care Partnerships. They will use quality assurance methods and tools such as NCQA accreditation standards, Health Plan Employer Data and Information Set (HEDIS), Consumer Assessment of Health Plan Survey (CAHPS) data and/or other quality improvement data. The standards used will be adapted from the 1115 Waiver required of the Medicaid managed care Partnership's entities. This will allow comparisons across provider and patient cohorts. Quality measures will be required of all managed care entity contractors and sub-contractors providing coverage and services to the KCHIP children.

CAHPS is utilized for the KCHIP population under the PCCM and managed care system. The state is administering and analyzing the CAHPS questionnaire for families enrolled in KCHIP. The KenPAC program of PCCM will remain until the program is bid out to a full managed care system. CAHPS and HEDIS will also be utilized when the population is bid out to a managed care program.

Access and utilization data are also maintained for PCCM and the managed care system. The state is analyzing claims data to evaluate access and utilization by children in PCCM and Managed Care, by regions of the state and by age.

EPSDT administrative data are collected through new codes developed for providers to record recipient encounters. These codes are used by PCCM providers and managed care organizations; thus, the state can generate EPSDT data for both KCHIP enrolled children in PCCM and Managed Care.

Immunizations are more difficult to track for KCHIP children under PCCM. The Department for Medicaid Services has been discussing alternative solutions to improving