Program Quality and Outcomes
Welcome to the Program Quality and Outcomes Page.
The division measures, analyzes and reports health outcomes of Kentucky Medicaid members. The Division also oversees managed care organizations (MCOs) to ensure compliance with all federal and state regulations and contract provisions.
The division is made up of three branches:
- Disease and Case Management Branch: Reviews MCO and fee-for-service disease and case management programs, oversees the early and periodic screening, diagnostic and treatment benefit, coordinates state fair hearings for Medicaid service denials and coordinates disenrollment for cause requests.
- Managed Care Oversight - Quality Branch: Oversees the work of the External Quality Review Organization (EQRO) to measure managed care organization (MCO) quality outcomes; monitors EQRO contract for compliance; reviews and analyzes healthcare effectiveness data and information set scores and consumer assessment of healthcare providers and systems surveys to measure effectiveness of MCOs and assess the quality of care.
- Managed Care Oversight - Contract Management Branch: Reviews MCO activities to ensure compliance with all applicable regulations and contract provisions and issues corrective action plans to MCOs found in violation of contract provisions.