As outlined in the Code of Federal Regulations (CFR) Title 42, Chapter IV, Subchapter C, Part 438, Subpart E, Quality Measurement and Improvement, Texas is required to have a Texas Managed Care Quality Strategy approved by the Centers for Medicare & Medicaid Services (CMS). Every three years, Texas must review and update the quality strategy. The results of the review must be made available to the public, and the updated strategy must be submitted to the CMS.
It is the goal of HHSC to use its Managed Care Quality Improvement Strategy to:
- Transition from volume-based purchasing models to a pay-for-performance model
- Improve member satisfaction with care
- Reduce payments for low quality care
It is the intention of HHSC to achieve these goals through the mechanisms described in this Strategy, including:
- Program integrity monitoring through both internal and external processes
- Implementation of financial incentives for high performing managed care organizations and financial disincentives for poor performing managed care organizations
- Developing and implementing targeted initiatives that encourage the adoption by managed care organizations of evidence-based clinical and administrative practices
HHSC’s fundamental commitment is to contract for results. HHSC defines a successful result as the generation of defined, measurable, and beneficial outcomes that satisfy the contract requirements and support HHSC’s missions and objectives.
Current Texas Managed Care Quality Strategy, as of July 2017.
Pending edits to Texas Managed Care Quality Strategy.
- The Texas Managed Care Quality Strategy is being updated to include new managed care requirements outlined in CFR 42 438, and to reflect the changes made during Amendment 14 which was approved by CMS on August 24, 2017, and on September 1, 2017, which transitioned recipients of the Medicaid for Breast and Cervical program and Adoption Assistance and Permanency Care Assistance programs to managed care. Items in tracked changes represent the only changes being made to the Texas Managed Care Quality Strategy. Updates were submitted for CMS review on March 2, 2018.
- Edited Texas Managed Care Quality Strategy (PDF)
For more information please email Texas Medicaid Waivers.