Medical Assistance and Children's Health Insurance Program Managed Care Quality Strategy for the Commonwealth (request for public comment)

The Centers for Medicare & Medicaid Services (CMS) requires states to draft and implement a written quality strategy for assessing and improving the quality of health care and services furnished by managed care organizations (MCO) that have an agreement with the Department of Human Services (Department). As a result, the Department has developed the MA and CHIP Managed Care Quality Strategy (MCQS), which discusses the various initiatives the Department has implemented to improve the quality of care for individuals receiving services through its managed care programs.

The MCQS for the Commonwealth is not intended to comprehensively describe all activities undertaken by the Department to assure the quality of care furnished to individuals receiving services through its managed care programs. The MCQS is an updated version of the previous quality strategy submitted to CMS in December 2023, and describes initiatives, strategies and processes to improve, evaluate and monitor member access to high quality, timely and preventive care through the Medicaid and CHIP managed care delivery system.

This MCQS provides a roadmap for the Department to support improved quality for all MA managed care and CHIP members. Across the Department and throughout the MCQS, the Department strives to improve the health of members enrolled in its managed care programs through strategic initiatives that support four overarching goals:

1. Increase access to healthcare services.
2. Improve the health outcomes of populations by providing and assuring access to preventative care.
3. Provide equitable, whole-person care through coordinated and integrated services.
4. Promote efficient and effective use of taxpayer resources by providing appropriate utilization of services.
   

Public Comment

The Department is making available for public review and comment the Medical Assistance (MA) and Children's Health Insurance Program (CHIP) Managed Care Quality Strategy for the Commonwealth. The MCQS for the Commonwealth can be viewed at pa.gov/agencies/dhs/resources/medicaid/managed-care-quality-strategy. Interested persons are invited to submit comments regarding the MCQS for the Commonwealth to the Department at RA-PWQualityStrategy@pa.gov. Comments received within 30 days will be reviewed and considered before the MCQS is submitted to CMS for review.

This notice was published by the Department of Human Services in the October 17, 2026, edition of the Pennsylvania Bulletin.