Medicaid & Safety Net Providers

The Medicaid program (Title XIX of the Social Security Act) is a state administered program that provides public health coverage for low-income Americans, financing health and long-term care services for over 55 million people, including families, people with disabilities, and the elderly.

Value Driven Health Care (VDHC) describes a growing movement towards cost-sensitive payment systems which reward health care providers for higher quality care. Value Based Health Care relies upon effective use of two related strategies: (1) Pay-for-Performance or “Value-Based Purchasing” and (2) Clinical Quality Measurement.

Value-Driven Health Care (HHS)

Pay-for-Performance

• "Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending" Report (not a U.S. Government Web site)
• Descriptions of Selected Performance Incentive Programs (pdf - CMS)
• Physician Pay-for-Performance in Medicaid: A Guide for States
  (not a U.S. Government Web site)
• Medicaid Information Technology Architecture - MITA (CMS)

Quality Measurement

• National Quality Measures Clearinghouse
• Quality Measures Compendium – Medicaid and SCHIP Quality Improvement (pdf – CMS)
• Medicare Quality Improvement Organization Quality Improvement Tools
  (not a U.S. Government Web site)

The Deficit Reduction Act of 2005 (DRA) (CMS) was signed into law February 8, 2006. In 2006, the Administration estimated that the DRA would reduce the growth in Medicare spending by more than $6 billion and reduce the growth in Medicaid spending by nearly $5 billion, over five years.

To determine an individual's eligibility, see Medicaid Eligibility (CMS).

• For language authorizing payments to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) see Sec. 702 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (H.R.5601).
  
  
• Guidance from CMS on Medicaid Prospective Payment System (PPS) for FQHCs and RHCs (pdf - CMS).
  
  
• Q's and A's regarding PPS (pdf - not a U.S. Government Web site).

For information on how to better integrate Medicare and Medicaid services for dual eligibles, see State Guide to Integrated Medicare and Medicaid Models (pdf - CMS).

The Early and Periodic Screening, Diagnostic, and Treatment service is Medicaid's comprehensive and preventive child health program for individuals under the age of 21.

• EPSDT and Title V Collaboration to Improve Child Health
• EPSDT Covered Benefits (CMS)
• EPSDT State Agency Responsibilities (CMS)

• Policy Information Notice 04-05: Medicaid Reimbursement for Behavioral Health Services.
  
  
• APHSA/NASMD Issue Brief: Serving the Needs of Medicaid Enrollees with Integrated Behavioral Health Services in Safety Net Primary Care Settings (pdf - not a U.S. Government Web site).

Medicaid State Waiver Program Demonstration Projects (CMS) - through this link, you can see what kinds of waivers and demonstrations have been proposed and/or approved in your state.

Links to State Medicaid Agencies (not a U.S. Government Web site).

We at HRSA will continue to ensure that you receive relevant information from us, but we encourage you to use the link below to sign up for the CMS Partner Listserv. The Listserv will allow you, and those you work with, to receive notices on CMS training, CMS products, issuance of new CMS policies, and other notices enabling your providers and the people they serve to make better use of CMS programs.

See CMS Mailing Lists (CMS).