§1320b–9b Adult Health Quality Measures

Summary

The Secretary must pick and publish a recommended core set of adult health quality measures for adults on Medicaid, using the same process used for child health measures. The measures should include ones already used in public and private plans and in systems that track how long people have insurance. The Secretary must publish the recommended set for comment by January 1, 2011 and an initial core set by January 1, 2012. By January 1, 2013 the Secretary must create a standard reporting format and encourage States to use it. Within 12 months after the recommended set is released, the Secretary must set up a Medicaid Quality Measurement Program like the pediatric program. Not later than 24 months after that program starts, and every year after, the Secretary must publish suggested updates based on testing and review. The core set and its updates must include behavioral health measures, and starting with State reports for 2024 States must use those behavioral health measures and the standard format. The Secretary must report to Congress by January 1, 2014 and every 3 years after with similar information. Nothing in this law limits what Medicaid must cover or requires only evidence-based services. Each State with a Medicaid plan or waiver must report every year to the Secretary which adult health quality measures it uses and state-specific information on care quality, including external reviews and benchmark plans. The Secretary must collect, analyze, and publish those state reports by September 30, 2014 and annually after that. The law sets aside $60,000,000 from the U.S. Treasury for each fiscal year 2010 through 2014 to carry out these rules. The funds remain available until spent, and at least $15,000,000 must be used to carry out the child measures program under section 1320b–9a(b).