§1320b–9b Adult Health Quality Measures

Summary

The Secretary of Health and Human Services must pick and publish a recommended set of health quality measures for adults on Medicaid. The Secretary had to publish that recommendation by January 1, 2011 and an initial core set by January 1, 2012. By January 1, 2013 the Secretary must create a standard way for states to report these measures and encourage states to report them voluntarily. Starting with state reports for 2024, states must use every behavioral health measure in the core set when they report on behavioral health using the standard format. The Secretary must also set up a Medicaid Quality Measurement Program within 12 months after the recommended set is released, propose updates no later than 24 months after that and then yearly, include behavioral health in the core set for 2024 reports, and send a report to Congress by January 1, 2014 and every three years after. The law does not limit Medicaid to only services called “evidence-based.” Each state with a Medicaid plan must yearly tell the Secretary which adult quality measures it uses and give state-specific quality information, including results from external reviews of managed care. The Secretary must collect and publish the states’ reports by September 30, 2014 and every year after. Congress provided $60,000,000 for each fiscal year 2010 through 2014 to carry out these rules. Those funds stay available until spent, and at least $15,000,000 of each year’s money must be used for the related child quality measures program.