External Quality Review Annual Technical Report - New York State Department of Health

New York State (NYS) is dedicated to providing and maintaining the highest quality of care for Medicaid and Child Health Plus enrollees in managed care plans (MCPs). The New York State Department of Health (Department) Office of Health Insurance Programs (OHIP), and the Office of Health Services Quality and Analytics (OHSQA), employ an ongoing strategy to improve the quality of care provided to plan enrollees and ensure the accountability of these plans.

Each year, per federal regulations, an external quality review is conducted by a qualified External Quality Review Organization (EQRO) to analyze and evaluate the quality, timeliness, and access to healthcare services that MCPs furnish to Medicaid and Child Health Plus enrollees. At the end of each annual external quality review process, the EQRO produces External Quality Review Annual Technical Reports (ATRs).

Each ATR 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
  • Validation of Network Adequacy
  • Administration of Quality-of-Care Surveys

Each ATR also includes an MCP-specific section that provides the EQRO's assessment of the MCP's strengths and opportunities for improvement in the areas of quality, timeliness, and accessibility of services. For areas in which the plan has opportunities for improvement, recommendations are provided for improving the quality of health care services. To achieve full compliance with federal regulations, this section also includes an assessment of the degree to which each MCP has effectively addressed the recommendations for quality improvement in the previous year's ATR. MCPs are given the opportunity to describe current and proposed interventions that address identified areas of concern, as well as an opportunity to explain areas that the MCP did not feel were within its ability to improve. The MCP's response to the previous year's recommendations is appended to the MCP-specific section of the report.

To provide the most consistent presentation of this varied information, ATRs are prepared based on data for the most current calendar year available. Where possible, data for prior calendar years may also be included for trending purposes. Additionally, when available and appropriate, MCP data are compared with statewide and national benchmarks.

Reporting Year 2024

For Reporting Year 2024, there are two annual technical reports containing information on four (4) Medicaid product lines (mainstream Medicaid Managed Care, HIV Special Needs Plans, Health and Recovery Plans, and Managed Long-Term Care) and the Child Health Plus program.

The first report includes information and results for mainstream Medicaid Managed Care (MMC, 12 MCPs), Child Health Plus (CHPlus, 12 MCPs), HIV Special Needs Plans (HIV SNP, 3 MCPs), and Health and Recovery Plans (HARP, 12 MCPs). This report includes the optional Activity 9, Conducting Focus Studies of Health Care Quality.

The second report includes information and results for Managed Long-Term Care (MLTC) plans certified to provide Medicaid coverage in New York State, which includes Medicaid Advantage Plus (MAP, 12 MCPs), Partial Capitation (20 MCPs), and Program of All-Inclusive Care for the Elderly (PACE, 9 MCPs).

For both reports, the Network Adequacy Plan-Level tables include data for all four quarters of the reporting year.

  1. New York State Medicaid Managed Care and Child Health Plus Programs 2024 External Quality Review Annual Technical Report - April 2026 (PDF)
  2. New York State Medicaid Managed Long-Term Care 2024 External Quality Review Annual Technical Report - April 2026 (PDF)

Reporting Year 2023

For Reporting Year 2023, there are two annual technical reports containing information on four (4) Medicaid product lines (mainstream Medicaid Managed Care, HIV Special Needs Plans, Health and Recovery Plans, and Managed Long-Term Care) and the Child Health Plus program.

The first report includes information and results for mainstream Medicaid Managed Care (MMC, 12 MCPs), Child Health Plus (CHPlus, 12 MCPs), HIV Special Needs Plans (HIV SNP, 3 MCPs), and Health and Recovery Plans (HARP, 11 MCPs).

The second report includes information and results for Managed Long-Term Care (MLTC) plans certified to provide Medicaid coverage in New York State, which includes Medicaid Advantage Plus (MAP, 12 MCPs), Partial Capitation (23 MCPs), and Program of All-Inclusive Care for the Elderly (PACE, 9 MCPs). New for the 2023 reporting year, the two annual technical reports include a new section on Validation of Network Adequacy.

  1. New York State Medicaid Managed Care and Child Health Plus Programs 2023 External Quality Review Annual Technical Report - April 2025 (PDF)
  2. New York State Medicaid Managed Long-Term Care 2023 External Quality Review Annual Technical Report - April 2025 (PDF)

Reporting Year 2022

For Reporting Year 2022, there are two annual technical reports containing information on four (4) Medicaid product lines (mainstream Medicaid Managed Care, HIV Special Needs Plans, Health and Recovery Plans, and Managed Long-Term Care) and the Child Health Plus program.

The first report includes information and results for mainstream Medicaid Managed Care (MMC, 13 MCPs), Child Health Plus (CHPlus, 13 MCPs), HIV Special Needs Plans (HIV SNP, 3 MCPs), and Health and Recovery Plans (HARP, 11 MCPs). New for the 2022 reporting year, the MMC, CHPlus, HIV SNP, and HARP results have been combined into one report.

The second report includes information and results for Managed Long-Term Care (MLTC) plans certified to provide Medicaid coverage in New York State, which includes Medicaid Advantage Plus (MAP, 12 MCPs), Partial Capitation (23 MCPs), and Program of All-Inclusive Care for the Elderly (PACE, 9 MCPs).

  1. New York State Medicaid Managed Care and Child Health Plus Programs 2022 External Quality Review Annual Technical Report - April 2024 (PDF)
  2. New York State Medicaid Managed Long-Term Care 2022 External Quality Review Annual Technical Report - April 2024 (PDF)

Reporting Year 2021

For Reporting Year 2021, there are four annual technical reports containing information on four (4) Medicaid product lines (mainstream Medicaid Managed Care, HIV Special Needs Plans, Health and Recovery Plans, and Managed Long-Term Care) and the Child Health Plus program. Reporting year 2021 is the first year that Managed Long Term Care (MLTC) plans have been included in the annual technical report.

The first report includes information and results for mainstream Medicaid Managed Care and Child Health Plus (MMC/CHPlus, 13 MCPs).

The second report includes information and results for HIV Special Needs Plans (HIV SNP, 3 MCPs).

The third report includes information and results for Health and Recovery Plans (HARP, 12 MCPs).

The fourth report includes information and results for MLTC plans certified to provide Medicaid coverage in New York State, which includes Medicaid Advantage Plus (MAP, 13 MCPs), Partial Capitation (25 MCPs), and Program of All-Inclusive Care for the Elderly (PACE, 9 MCPs).

  1. New York State Mainstream Medicaid Managed Care 2021 External Quality Review Annual Technical Report - April 2023 (PDF)
  2. New York State Medicaid Managed Care HIV Special Needs Plans 2021 External Quality Review Annual Technical Report - April 2023 (PDF)
  3. New York State Medicaid Managed Care Health and Recovery Plan 2021 External Quality Review Annual Technical Report - April 2023 (PDF)
  4. New York State Medicaid Managed Long Term Care 2021 External Quality Review Annual Technical Report - April 2023 (PDF)

Reporting Year 2020

For the 2020 Reporting Year, there are three annual technical reports containing information on three (3) Medicaid product lines (mainstream Medicaid Managed Care, HIV Special Needs Plans, and Health and Recovery Plans) and the Child Health Plus Program. Reporting year 2021 is the first year that Health and Recovery Plans have been included in the annual technical report.

The first report includes information and results for mainstream Medicaid managed care and Child Health Plus (MMC/CHPlus, 13 MCPs),

The second report includes information and results for HIV Special Needs Plans (HIV SNP, 3 MCPs)

The third report includes information and results for Health and Recovery Plans (HARP, 12 MCPs)

  1. New York State Medicaid Managed Care 2020 External Quality Review Annual Technical Report - April 2022 (PDF)
  2. New York State Medicaid Managed Care HIV Special Needs Plans 2020 External Quality Review Annual Technical Report - April 2022 (PDF)
  3. New York State Health and Recovery Plan (HARP) Medicaid Managed Care 2020 External Quality Review Annual Technical Report - April 2022 (PDF)

Reporting Year 2019

For reporting year 2019, there are two annual technical reports containing information on two (2) Medicaid product lines (mainstream Medicaid Managed Care and HIV Special Needs Plans) and the Child Health Plus program.

The first report includes information and results for Medicaid managed care and Child Health Plus (MMC/CHPlus, 15 MCPs),

The second report includes information and results for HIV Special Needs (HIV SNP, 3 MCPs)

  1. Annual External Quality Review Technical Report - New York State Medicaid Managed Care Plans (PDF)
  2. Annual External Quality Review Technical Report - New York State HIV Special Needs Medicaid Managed Care Plans (PDF)