Description: The term "apple health" includes both medicaid and children's health insurance program (CHIP) populations. The Washington state QS outlines a comprehensive plan that incorporates assessment, monitoring, coordination and ongoing performance improvement processes and activities that are directed at continually improving the medicaid apple health managed care program. The QS is the vehicle used by the Washington state health care authority (HCA) to communicate the vision, goals and monitoring strategies addressing health care quality, timeliness, and access. The QS also serves to meet the requirements specified by C.F.R. 438.340, which requires the development and maintenance of a medicaid quality strategy.


•	Articulating guiding principles for developing and implementing a quality strategy and prioritizing activities related to quality management;
•	Describing activities related to the development, evaluation and updating of the strategy to reflect stakeholder input and continuous improvement;
•	Providing structure and assignment of responsibilities for implementing the activities as described in the QS;
•	Identifying procedures for assessment of quality and appropriateness of care delivered by managed care organizations;
•	Establishing clear aims and objectives to drive improvements in care delivery and outcomes, and identifying the metrics by which progress will be measured;
•	Outlining the monitoring activities that will be used to ensure that the services provided to medicaid managed care members conform to professionally recognized standards of practice, contract requirements, and state and federal rules and regulations;
•	Describing processes used to identify and pursue opportunities for improvements in health outcomes, accessibility, and value-based payment methodologies;
•	Clearly articulating the complex set of programs and populations that require support as part of an integrated managed care delivery system.

•

Articulating guiding principles for developing and implementing a quality strategy and prioritizing activities related to quality management;

•

Describing activities related to the development, evaluation and updating of the strategy to reflect stakeholder input and continuous improvement;

•

Providing structure and assignment of responsibilities for implementing the activities as described in the QS;

•

Identifying procedures for assessment of quality and appropriateness of care delivered by managed care organizations;

•

Establishing clear aims and objectives to drive improvements in care delivery and outcomes, and identifying the metrics by which progress will be measured;

•

Outlining the monitoring activities that will be used to ensure that the services provided to medicaid managed care members conform to professionally recognized standards of practice, contract requirements, and state and federal rules and regulations;

•

Describing processes used to identify and pursue opportunities for improvements in health outcomes, accessibility, and value-based payment methodologies;

•

Clearly articulating the complex set of programs and populations that require support as part of an integrated managed care delivery system.

The public comment period for the Washington state managed care QS document is from November 2 through December 2, 2020, at 5 p.m. (Pacific). You can email comments to larita.paulsen@hca.wa.gov.

The QS document can be found at the following link: https://www.hca.wa.gov/assets/program/13-0053-washington-state-managed-care-quality-strategy.pdf.

For additional information, contact Larita L.M. Paulsen, BSN, MPA, Supervisor, Medicaid Compliance Review Unit, HCA, email larita.paulsen@hca.wa.gov.