As federal regulations seek greater consistency in Medicaid quality measurement, it will be challenging, but essential, to find a balance that realizes the benefits of standardization across states while maintaining the flexibility of states to innovate and address unique needs and circumstances.
State quality measurement systems that hold Medicaid managed care organizations accountable are at a crossroads. To date, states have had tremendous flexibility to design their quality measurement systems, including selecting metrics, benchmarks, and incentives that are tailored to their Medicaid populations and address state-specific gaps in care.
Federal regulations released in April 2016 will impose more standardization—requiring all states to use a quality rating system that draws from a core set of measures and common methodology. Greater consistency across states could facilitate national benchmarking, support a federal quality improvement agenda, and reduce the burden of data collection and reporting.
- Federal rules and regulations
- State quality rating systems
- Advantage of national standards
- Advantage of state flexibility
- Balancing standardization and flexibility