During this meeting session, staff presented policy options for the external quality review (EQR) process as part of MACPAC’s work on strengthening managed care oversight and accountability.
The 2024 Medicaid managed care rule requires the EQR annual technical report include any outcomes data and results from quantitative assessments of performance improvement plans, performance measures, and network adequacy. The requirement does not apply to the triennial compliance review. Also, the Centers for Medicare & Medicaid Services (CMS) protocol for the annual technical report does not include mandatory templates or requirements for standardized content that could improve the usability of EQR findings summarized in the reports.
The Commission discussed the findings from the prior work in light of the 2024 Medicaid managed care rule. Specifically, the Commission examined whether there were additional areas for improvement not addressed by the rule regarding how EQR could be structured to use outcomes data and improve the usability of EQR findings by CMS, states, and other stakeholders.
This session described key challenges with the current requirements for the EQR process, and explored policy options to address these challenges. Staff also solicited Commissioner feedback on these policy options.
