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Quality & Practice

Initiatives Focused on the Medicaid and CHIP Population

Medicaid Emergency Psychiatric Demonstration

Medicaid does not reimburse care rendered to beneficiaries ages 21 through 64 in “Institutions of Medical Disease” (IMDs), which may result in them going to the emergency department.  Under this demonstration project, CMS will provide “up to $75 million in federal Medicaid matching funds over three years to enable private psychiatric hospitals, also known as IMDs, to receive Medicaid reimbursement for treatment of psychiatric emergencies, described as suicidal or homicidal thoughts or gestures or determined to be a danger to self or others, and, provided to eligible Medicaid enrollees aged 21 to 64 who have an acute need for treatment. Historically, Medicaid has not paid IMDs for these services without an admission to an acute care hospital first.”  It is no longer an active demonstration but results are not yet available.

Medicaid Incentives for the Prevention of Chronic Diseases Model

This initiative provided grants to states that they could use to incentivize Medicaid beneficiaries to engage in healthier behavior.  The program had to be evidence based and had to include at least one of the following:  tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or in the case of a diabetic, improving the management of the condition.  There is no state responsibility for contributing funds.

Medicaid Innovation Accelerator Program

The initiative is described on the website as “While complementing other federal-state delivery system reform efforts, this new technical assistance program will help jumpstart innovation by strengthening federal tools and resources to support states in advancing Medicaid-specific delivery system reform.  The IAP will develop technical resources to support innovation through four key functions:
  • Identify and advance new models
  • Data analysis
  • Improved quality measurements
  • State-to-state learning, rapid-cycle improvement, and federal evaluation

Strong Start for Mothers and Newborns Initiative: Effort to Reduce Early Elective Deliveries

In order to decrease the number of early elective deliveries, CMS is implementing the following:
  • “Promoting Awareness - CMS supported broad-based awareness efforts in partnership with leading organizations, including the March of Dimes and ACOG, as well as other professional and advocacy organizations. These efforts will target pregnant women, their families, their health providers, and organizations that serve pregnant women.
  • Spreading Best Practices - to help speed and spread the adoption of best practices that reduce early elective deliveries, CMS will build on the efforts and infrastructure of HHS’ Partnership for Patients, and the commitment of the nearly 4,000 participating institutions. The effort will work with the Partnership for Patients’ 26 Hospital Engagement Networks to make measurable goals for participating hospitals, and to give technical assistance in testing strategies and putting them into place. The existing Partnership for Patients infrastructure will also support efforts to collect data, measure success and promote quality improvement.
  • Promoting Transparency - CMS will support efforts to collect performance data, measure success, and assist with continuous quality improvement.”

Strong Start for Mothers and Newborns Initiative: Enhanced Prenatal Care Models

This initiative provided grants to organizations to “test three evidence-based maternity care service approaches that enhance the current care delivery and address the medical, behavioral and psychosocial factors that may be present during pregnancy and contribute to preterm-related poor birth outcomes. Awardees will test one of the three following interventions, but cannot use funds to supplement or supplant any funding sources, including Medicaid and CHIP reimbursement:

  • Enhanced Prenatal Care through Centering/Group Visits – group prenatal care that incorporates peer-to-peer interaction in a facilitated setting for health assessment, education and psycho-social support.   
  • Enhanced Prenatal Care at Birth Centers – comprehensive prenatal care facilitated by teams of health professionals including peer counselors. Services include collaborative practice, intensive case management, counseling and psycho-social support.  
  • Enhanced Prenatal Care at Maternity Care Homes – enhanced prenatal care including psychosocial support, education and health promotion in addition to traditional prenatal care. Services provided will expand access to care, improve care coordination and provide a broader array of health services.”