Medicare Quality Improvement Program

20 - Medicare Quality Improvement Program (Rev. 117, Issued: 08-08-14, Effective: 08-08-14, Implementation: 08-08-14) MAOs that offer one or more MA plans must have an ongoing Quality Improvement (QI) program for each of their plans. The purpose of a QI program is to ensure that MAOs have the necessary infrastructure to coordinate care, promote quality, performance, and efficiency on an ongoing basis. The requirements for the QI program are based in regulation at 42 CFR§ 422.152. For each plan, an MAO must: 1. Develop and implement a chronic care improvement program (CCIP) 42 CFR §422.152(c); 2. Develop and implement a quality improvement project (QIP) 42 CFR §422.152(d); 3. Develop and maintain a health information system (42 CFR §422.152(f)(1)); 4. Encourage providers to participate in CMS and HHS QI initiatives (42 CFR §422.152(a)(3)); 5. Implement a program review process for formal evaluation of the impact and effectiveness of the QI Program at least annually (42 CFR §422.152(f)(2)); 6. Correct all problems that come to its attention through internal surveillance, complaints or other mechanisms (42 CFR §422.152(f)(3)); 7. Contract with an approved Medicare Consumer Assessment of Health Providers and Systems (CAHPS®) vendor to conduct the Medicare CAHPS® satisfaction survey of Medicare enrollees (42 CFR §422.152(b)(5)); and, 8. Measure performance under the plan using standard measures required by CMS and report its performance to CMS (42 CFR §422.152(e)(i)). 9. Develop, compile, evaluate, and report certain measures and other information to CMS, its enrollees, and the general public. Responsible for safeguarding the confidentiality of the doctor-patient relationship and report to CMS in the manner required cost of operations, patterns of utilizations of services, and availability, accessibility, and acceptability of Medicare approved and covered services (42 CFR §422.516(a)). All MAOs, as part of their application to offer new MA products or expand the service area of an existing product, must submit a written Quality Improvement Program Plan (QIPP). The QIPP outlines the elements of an MAO’s QI Program and provides a framework for how a plan will execute each of the QI program requirements stipulated above. QIPPs are submitted to CMS as part of the contract and SNP application processes. QIPP templates are included in both the contract and SNP applications.