Recent and Pending Federal Reforms Related to Managed Care

Managed care offers health care purchasers and providers an important opportunity to improve the quality of health care that individuals receive. At the same time, devising and implementing managed care quality accountability arrangements represents a major challenge for purchasers generally and for Medicaid purchasers in particular. This paper, prepared for the National Academy for State Health Policy under a grant from the David and Lucile Packard Foundation, Center on the Future of Children, examines recent federal policy initiatives to promote quality in managed care and their implications for Medicaid managed care programs.
The paper begins with an overview of quality of care measurement and the current means by which Medicaid agencies create enforceable health care quality standards for the managed care organizations with which they contract. The paper then examines and reports on a series of recent and pending federal initiatives aimed at improving and strengthening quality of care available to managed care enrollees: the Balanced Budget Act of 1997, along with relevant implementing federal guidelines issued to date; the Consumer Bill of Rights, which was issued in late 1997 by the National Quality Commission and which was followed in 1998 with a Presidential Directive aimed at implementing Commission recommendations through administrative action; and the Health Insurance Portability and Accountability Act. In addition, the paper summarizes the principal elements of selected managed care quality-related legislation introduced during the 105* Congress.

1998.May_.recent.pending.federal.reforms.related.managed.care_.quality.pdf

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