Medicaid and CHPlus Quality Strategy

Overview

New York State (NYS) is dedicated to providing and maintaining the highest quality of care for enrollees in managed health care plans. The New York State Department of Health (NYSDOH) Office of Health Insurance Programs (OHIP), and the Office of Quality and Patient Safety (OQPS), employ an ongoing strategy to improve the quality of care provided to plan enrollees to ensure the accountability of these plans, and maintain the continuity of care to the public.

Federal regulation 42 CFR 438.340 requires that all states providing managed care must develop and publish a Quality Strategy. The purpose of the NYS Quality Strategy is as follows:

  • Establish a comprehensive quality improvement strategy for the NYS Medicaid/CHPlus program that is consistent with the National Quality Strategy;
  • Assess the quality of care that NYS Medicaid/CHPlus members receive;
  • Establish measurable goals of the NYS Medicaid/CHPlus program, set targets for improvement, and identify interventions to promote improvement

Each state must update their Quality Strategy at least every three years. The Quality Strategy is developed in collaboration with other state agencies such as the Office of Mental Health, the Office of Children and Family Services, the Office for People with Developmental Disabilities, and the Office of Addiction Services and Supports to capture a wide range of priorities. Metrics are carefully selected to align with those priorities and focus on areas for improvement. NYSDOH is increasingly emphasizing health equity throughout its work, including in the Quality Strategy through stratified data, identifying disparities, and promoting person-centered care. NYSDOH aims to integrate the Quality Strategy with the agency's ongoing work to further support its goals.

Current and Historic Quality Strategy Documents

Current
  • Final Quality Strategy for The New York State Medicaid/ Child Health Plus Insurance Program CY 2023-2025 - (PDF) - Published September 5, 2024
  • Public Comment Responses for The New York State Medicaid/ Child Health Plus Insurance Program CY 2023-2025 - (PDF) - Published September 5, 2024
  • Draft Quality Strategy for The New York State Medicaid / Child Health Plus Insurance Program CY 2023-2025 - Draft for Public Comment - (PDF) - Published May 17, 2024
Historic
  • Final Quality Strategy for The New York State Medicaid/ Child Health Plus Insurance Program CY 2020-2022 - (PDF) - Published March 14, 2022
  • Draft Quality Strategy for The New York State Medicaid / Child Health Plus Insurance Program CY 2020-2022 - Draft for Public Comment - (PDF) - Published October 20, 2021
  • Final Quality Strategy for the New York State Medicaid Managed Care Program - (PDF) - Published October 2015
  • Draft Quality Strategy for the New York State Medicaid Managed Care Program - (PDF) - Published September 2015

External Quality Review Reports

Federal regulation 42 CFR 438.340 also requires that states evaluate the effectiveness of the Quality Strategy. NYS satisfies this requirement through the External Quality Review Annual Technical Report, conducted by the External Quality Review Organization, Island Peer Review Organization (IPRO).

The External Quality Review Annual Technical Report aggregates, analyzes, and evaluates information on the quality, timeliness, and access to healthcare services that managed care plans furnish to Medicaid recipients.

Each report summarizes the External Quality Review Activities including:

  • Validation of Performance Improvement Projects
  • Validation of Performance Measures
  • Review of Compliance with Medicaid and Children's Health Insurance Program Standards
  • Administration of Quality-of-Care Surveys

To view the External Quality Review Annual Technical Reports, please visit this webpage.

Monitoring

In addition to the External Quality Review Reports, NYSDOH continuously monitors the Quality Strategy metrics and progress toward its goals. NYSDOH also monitors other indicators which might be included in future Quality Strategies.

Performance data related to the Quality Strategy as well as other NYSDOH initiatives are publicly available at:

Contact

Department of Health - Bureau of Health Access, Policy, and Innovation
qualitystrategy@health.ny.gov
(518) 473-2160