The Medicaid Managed Care Quality Strategy is the framework used by the DC Department of Health Care Finance (DHCF) for guiding the agency's mission to provide comprehensive, cost-effective, and quality healthcare services to District Residents with the goal of improving health outcomes. The Quality Strategy documents DHCF’s approach to assessing and improving quality of health care and services received by beneficiaries enrolled in Managed Care Plans (MCP).
DHCF has updated its Quality Strategy for 2024-2027 and is requesting public comment. As outlined in the Code of Federal Regulations (CFR) Title 42, Chapter IV, Subchapter C, Part 438, Subpart E, Quality Measurement and Improvement, the Department of Health Care Finance is required to have a DC Medicaid Managed Care Quality Strategy approved by the Centers for Medicare & Medicaid Services (CMS). Every three years, DHCF 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.
The final draft of the DC Medicaid Managed Care Quality Strategy is available on this website. DHCF will accept public comments on the draft DC Medicaid Managed Care Quality Strategy through Sunday, January 7, 2024. Interested parties may send written comments concerning the DC Medicaid Managed Care Quality Strategy to Fatorma Greene, Management Analyst, Division of Quality and Health Outcomes, Department of Health Care Finance, 441 4th Street, NW, Suite 900S, Washington, D.C. 20001, or via email at [email protected].
The Quality Strategy can also be found in the DC Register at
https://www.dcregs.dc.gov/Common/DCR/Issues/IssueDetailPage.aspx?issueID=1063
External Quality Review Organization (EQRO)
The DHCF contracts with Qlarant, an External Quality Review Organization (EQRO), to evaluate the quality, access, and timeliness of services provided to Medicaid managed care enrollees. Evaluation findings are published in an Annual Technical Report (ATR). To access EQRO ATRs, click here.
Consumer Report Card
Each year the DHCF publishes an MCP report card that compares how the Medicaid MCPs compare to one another in key areas such as access to care.
