This webpage contains information related to the MA Quality Improvement program. Within this site, we provide the Quality Improvement program requirements and relevant HPMS memos and resource information. The Quality Improvement program requirements for MA organizations are described in 42 CFR 422.152. Guidance may also be found in the CCIP Resource Document and in Chapter 5 of the Medicare Managed Care Manual. Both are available as downloads below. For further information on this topic, please ...
Using data to track health care quality improvements at the local level; Protecting the integrity of the Medicare Trust Fund by ensuring that Medicare pays only for services and goods that are reasonable and necessary and that are provided in the most appropriate setting; and · Protecting beneficiaries by expeditiously addressing individual complaints, such as beneficiary complaints; provider-based notice appeals; violations of the Emergency Medical Treatment and Labor Act (EMTALA); and other ...
Medicare's Quality Improvement Organization Program: Maximizing Potential . CMS' response to that report outlines improvements, based on an extensive CMS review and recommendations from the...
The Center for Medicaid and CHIP Services (CMCS) Quality Improvement (QI) Program provides state Medicaid and CHIP agencies and their quality improvement partners with the information, tools, and e...
CMS uses quality improvement and quality measurement to achieve the goals and priorities of the Meaningful Measures Framework. The purpose of the Framework is to improve outcomes for...
Savings Program—in the country, drives transparency through public tools such as Care Compare, and strategically uses the Quality Improvement Organizations, which are health quality...
Insurance Program (CHIP), and/or private health insurance plans • Looks forward to a post... {Link} • In April 2021, CMS targeted the efforts of the Quality Improvement Organizations...
With the Centers for Medicare & Medicaid Services (CMS) National Quality Strategy, CMS will set and raise the bar for a resilient, high-value health care system that promotes quality outcomes, safety, equity, and accessibility for all individuals, especially for people in historically underserved and under-resourced communities. Quality in Motion: Acting on the CMS National Quality Strategy (PDF) emphasizes connections across the CMS National Quality Strategy and details how CMS is putting quali...
Dora Hughes ; Dora Hughes, M.D., M.P.H., is the Chief Medical Officer and Director of the Center for Clinical Standards and Quality (CCSQ) for the Centers for Medicare & Medicaid Services (CMS). CCSQ is primarily responsible for executing all national clinical, quality, and safety standards for healthcare facilities and providers, as well as establishing coverage determinations for items and services that improve health outcomes for Medicare beneficiaries. Previously, Dr. Hughes served as Chief ...
The quality-measurement movement began more than 20 years ago and has resulted in transparent quality-performance information, accountability, and improvements. At the same time, proliferation of quality measures has caused confusion, increased reporting burden, and misalignment of approaches for common clinical scenarios. The Centers for Medicare and Medicaid Services (CMS) and public–private partnerships have therefore moved toward creating more parsimonious sets of measures. Although some p...