The Centers for Medicare & Medicaid Services (CMS) requires in 42 CFR §438.340, each state contracting with a managed care organization (MCO) to draft and implement a written quality strategy for assessing and improving the quality of health care and services furnished by the MCO. At least every three years, Texas must review and update its quality strategy. The results of the review must be made available to the public, and the updated strategy must be submitted to the CMS. The quality strategy is reviewed each year by the External Quality Review organization in its Annual Technical Report available on HHSC’s website.
HHSC uses its Managed Care Quality Strategy to assess and improve the quality of health care and services provided through the managed care system, prioritizing the following goals:
- Promoting optimal health for Texans
- Strengthening person and family engagement as partners in their care
- Keeping patients free from harm
- Providing the right care in the right place at the right time
- Promoting effective practices for people with chronic, complex, and serious conditions
- Attracting and retaining high-performing Medicaid providers, including medical, behavioral health, dental, and long-term services and supports providers
Transforming Medicaid and the Children’s Health Insurance Program into a value-based system is a long-term endeavor involving many decisions and coordinated actions by HHSC programs and stakeholders. HHSC constantly works to make sure people get better healthcare and stay healthy, all while keeping the costs under control.
Texas’ quality strategy was updated and submitted to CMS in March 2021, in compliance with the requirement to update the strategy every three years.
Shortly after submission to CMS in March 2021, HHSC identified the need for small changes to the strategy. This revised quality strategy, submitted to CMS in September 2021, is named as the July 2021 Texas Managed Care Strategy in the link below.
Texas Managed Care Quality Strategy Versions
- March 2021 – Texas Managed Care Quality Strategy Submitted (PDF)
- July 2021 – Texas Managed Care Quality Strategy (PDF)
For more information, email MCD Managed Care Quality.