Quality Measurement

Below are some of the quality measurement tools that are being used to ensure high quality of care in KanCare.

Centers for Medicare & Medicaid Services Special Terms Conditions Reporting

External Quality Review Reports

Network Adequacy

Quality Dashboard

Quality Management Strategy (QMS)

KanCare Quality Management Strategy

The Kansas Department of Health & Environment (KDHE) and the Kansas Department for aging and Disability Services (KDADS) changed its Quality Management Strategy (QMS) to match the Code of Federal Regulations (CFR) at 42 CFR 438.340 in July 2018. KDHE and KDADS are responsible for updating the QMS no less than once every three years and, as needed, based on progress, comments from partners, and/or changes in legislative, State or Federal policies.

 

Performance Improvement Projects

The Centers for Medicare and Medicaid Services (CMS) requires Managed Care Organizations (MCO) to conduct performance improvement projects (PIPs) per 42 CFR 438330 and 4571240(b). A PIP is a pilot project designed to improve member health and quality of life. KanCare 2.0 requires each MCO to conduct at least 5 State approved PIPs. The Human Papillomavirus (HPV) PIP is done together by all three MCOs.  The MCOs must also conduct an additional PIP on Kan Be Healthy (KBH), our childhood Early Periodic Screening Diagnostic and Testing (EPSDT) program, when the MCOs’ overall rates drop below 85%.

Health Plan Accreditation

Each of the three KanCare health plans and their subcontractors is required to obtain accreditation by the National Committee for Quality Assurance (NCQA). The NCQA is an independent, 501 (c) (3) non-profit organization that assesses and scores the performance of health plans nationally. Plans are evaluated in the areas of quality management and improvement, utilization management, provider credentialing and consumers’ rights and responsibilities. By requiring the KanCare health plans to become NCQA accredited, we will ensure that each plan is deemed capable of providing the highest quality of care and service to Medicaid consumers. See their rankings here.

Evaluation Design

Under the terms of the KanCare Section 1115 demonstration, the State was to submit a proposed evaluation design for the demonstration to CMS within 120 days. The draft evaluation design incorporates measures from the KanCare contracts related directly to the goals of the KanCare program, which are to: 

After CMS and stakeholder feedback, the State submitted a final draft design for CMS review.

KanCare Evaluation Design 2020