MACPAC is examining the managed care external quality review (EQR) process as part of its work on strengthening managed care oversight and accountability.
Continuing the Commission’s work on EQR from 2023, staff reviewed prior work on EQR and presented an update on EQR requirements in light of the final Medicaid managed care rule released on May 10, 2024. The managed care rule requires that the annual technical report include any outcomes data and results from quantitative assessments of performance improvement plans, performance measures, and network adequacy.
The Commission discussed the findings from the prior work and if there were areas to explore for potential policy options regarding how EQR could be structured to use outcomes data and improve the transparency and usability of EQR findings by the Centers for Medicare & Medicaid Services, states, and other stakeholders.
