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Managed Care Oversight - Quality Branch Reports

Reports

Access and Availability Surveys and Reports

Annual telephone-based access and availability surveys conducted by EQRO for the Managed Care Oversight - Quality Branch to ensure that Kentucky MCO provider networks are following Medicaid managed care participation standards

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Comprehensive Evaluation Summary

Annual comprehensive program review of KDMS accountability strategy, monitoring mechanisms, and compliance assessment system of the Kentucky managed care program.

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EPSDT Validation Reports

Annual report comparing administrative data and medical record documentation to validate encounter data codes relevant to the receipt of EPSDT screening of children enrolled in Kentucky Medicaid managed care.

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HEDIS and CAHPS Reports

MCO HEDIS and CAHPS results as reported to DMS by each MCO. HEDIS is reported by MCOs to the National Committee for Quality Assurance and CAHPS is reported by MCOs to the Agency for Healthcare Research and Quality.

2016

2015

2013

2013

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MCO Annual Compliance Reviews

Annual on-site review and evaluation of MCO compliance with state and federal standards and state contract requirements.

2015

2014

2013

2012

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MCO Dashboards

Electronic tracking of key quality performance indicators over time.

Monthly Reports

Quarterly Reports

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Managed Care Progress Reports

Annual review of managed care progress for the year with recommendations of key performance for KDMS's consideration

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NCQA Health Plan Report Card

Performance Improvement Projects (PIPs)

EQRO annual evaluation of the MCO PIPs. Each MCO must conduct one PIP addressing a physical health issue and one PIP addressing a behavioral health issue. Collaborative statewide PIPs can also be conducted.

2015

2011

2009

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Pharmacy Program Reviews

Quarterly review of the MCO pharmacy program, preferred drug list, prior authorization process and drugs only covered with prior authorization

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Provider Network Validation Reports

Audit of provider information submitted by the MCOs with the information contained in KDMS provider data base

2017

2016

2015

2014

2013

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Quality of Care Focus Studies

Studies relating to patterns of care and/or operational issues that impact quality of care, financial performance or service delivery in managed care.

2016

2015

2014

2013

2012

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Quality Strategy

Comprehensive plan incorporating quality assurance monitoring and ongoing quality improvement processes to coordinate, assess and continually improve the delivery of quality care and services to participants in managed care

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Report Cards

Comparison of MCO performance on selected HEDIS measures and CAHPS results used to help member select a MCO during open enrollment periods

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Technical Reports

Report describes the way data from all EQRO-related activities were aggregated and analyzed and conclusions drawn regarding quality, timeliness and access to care provided by the MCOs. It includes assessment of DMS strengths and weaknesses and recommendations for improvement.

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Validation of Patient Level Claims

Comparison of MCO HEDIS reported rates to MCO encounter calculated rates.

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Validation of Performance Measures

Annual comparison of MCO performance data to performance targets and national benchmarks

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Contact Information
 

Division of Program Quality and Outcomes
Managed Care Oversight - Quality Branch
275 E. Main St., 6C-C
Frankfort, KY 40621
Phone: 502-564-9444

 

Last Updated 5/17/2017