Chronic Care Improvement Program (CCIP) and Quality Improvement

20.1 - Chronic Care Improvement Program (CCIP) and Quality Improvement Projects (QIP) (Rev. 117, Issued: 08-08-14, Effective: 08-08-14, Implementation: 08-08-14) 42 CFR §422.152(c) – (d) As required by regulation, each MAO must develop and implement a CCIP and QIP as part of its required QI Program. MAOs must conduct the same CCIP and QIP for all their non-SNP coordinated care plans offered under a specified contract, including employer group plans and Medical Savings Account plans (MSA) and Private Fee for Service (PFFS) plans that have contracted networks. MAOs must also implement a CCIP and QIP specific to each SNP plan offered, including when an MAO offers multiple SNPs of the same type under a contract. Only PFFS plans that do not have contracted networks, section 1833 and 1876 cost plans, and Program of All-Inclusive Care for the Elderly (PACE) plans are exempted from the CCIP and QIP requirements. The quality improvement model adopted by CMS for the CCIP/QIPs is based on The Plan-Do- Study-Act (PDSA) quality improvement model. PDSA is an iterative, problem-solving model used for improving a process or carrying out change. The four steps of the PDSA cycle provide a systematic, step-by-step, ongoing approach for quality improvement initiatives. Components of the PDSA are as follows: • Plan: Describes the processes, specifications, and output objectives used to establish the CCIP/QIP; • Do: Describes the progress of the implementation and the data collection plan; • Study: Describes the analysis of data to determine what impact the program has had on members. • Act: Summarizes action plan(s) based on findings; describes, in particular, the differences between actual and anticipated results, and describes specific actions or steps taken or planned based on current results. The MAO’s first step in implementing a QIP or CCIP is submitting a complete, stand-alone “Plan” section of the PDSA model for approval by CMS. Once that Plan is approved and implemented, MAOs are required to submit Annual Updates that are comprised of the Do, Study, and Act components of the PDSA model to report on the ongoing operations of that approved Plan. The Plans and Annual Updates for both CCIPs and QIPs are submitted to CMS through the “Quality and Performance” module of the Health Plan Management System (HPMS). CMS’s expectations regarding the information that is to be included in the Plan and Annual Update submittals are discussed in greater detail below. MAOs have access to detailed information about the submission requirements for the CCIP and QIP Plan and Annual Updates. Detailed information can be found in the CCIP and QIP User Guides available within the HPMS Quality and Performance module.