Quality Strategy

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.

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 will be a long-term endeavor involving many decisions and coordinated actions by HHSC programs and stakeholders. Ongoing efforts will support system-wide change to achieve better care and health for individuals and populations while managing healthcare costs.

In accordance with 42 CFR §438.340, each state contracting with a managed care organization (MCO) must draft and implement a written quality strategy for assessing and improving the quality of health care and services furnished by the MCO.  To comply with this requirement to update the strategy every three years, the strategy was updated and submitted to CMS in March 2021.

Shortly after submission to CMS in March 2021, HHSC identified the need for small changes to the strategy. The revised quality is the July 2021 Final Texas Managed Care Strategy link below. 

Texas Managed Care Quality Strategy Versions

For more information please email Texas Medicaid Waivers.