Health quality measures approved for adult Medicaid recipients as program faces growing pains

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The Centers for Medicare & Medicaid Services likely will focus on 24 health quality measures when evaluating care received by adult Medicaid beneficiaries, according to a draft from an Agency for Healthcare Research and Quality advisory panel released last week.

CMS and other Health and Human Services agencies will review and approve a final core set of quality measures by Jan. 1, 2012. The measures, which CMS will use to compare the quality of state Medicaid programs against each other, are focused on: prevention and health promotion; management of acute conditions; management of chronic conditions; family experiences of care; and availability of services. Within these groups are items such as flu shots for older adults, lipid screening for diabetics, and compliance with anti-psychotics for schizophrenics.

Reporting is voluntary for states, and CMS must develop a standardized reporting format for the core set of quality measures for Medicaid-eligible adults by Jan. 1, 2013.

In other state Medicaid news, data from two groups — the Center on Budget and Policy Priorities and Families USA — show that 24 states plan to trim $4.7 billion from state Medicaid programs as a result of four consecutive years of budget shortfalls, Reuters reported. This poses challenges to nursing homes that derive a significant portion of their revenue through the state-federal program. As mandated by the Affordable Care Act, Medicaid is scheduled to undergo an expansion to 32 million more people starting in 2014.

"The provider rate cuts are going to mean that fewer providers will offer Medicaid services by the time we get to 2014, and that's bad. It pulls in the opposite direction of where healthcare reform's trying to go," Mike Leachman of the Center on Budget and Policy Priorities told Reuters.