DIAMOND STATE HEALTH PLAN - QUALITY STRATEGY

The Delaware Quality Strategy 2023 previously known as Delaware Quality Management Strategy is a comprehensive plan incorporating quality insurance monitoring and ongoing improvement processes to improve the delivery of quality care. The Quality Strategy is an evolving document that undergoes regular reviews by DMMA, ensuring any necessary changes are made. Please see the changes and the 2023 Quality Strategy outlined below.

• Summary of Changes from the 2018 Quality Management Strategy to 2023 Quality Strategy
• 2023 Quality Strategy

Managed Care Program Annual Report (MCPAR)

CMS regulations at 42 CFR § 438.66(e) require states to submit a Managed Care Program Annual Report (MCPAR). Under the regulation, each state must submit to CMS, no later than 180 days after each contract year, a report on each managed care program administered by the state.

The annual report is part of CMS's overall strategy to improve access to services by supporting Federal and state access monitoring for Medicaid beneficiaries within a managed care delivery system.

The MCPAR report provides information in the following categories:

1. Program enrollment and service area expansions
2. Financial performance
3. Encounter data reporting
4. Grievances, appeals, and state fair hearings
5. Availability, accessibility, and network adequacy
6. Delegated entities
7. Quality and performance measures
8. Sanctions and corrective action plans
9. Beneficiary support system (BSS)
10. Program integrity

Each of the above categories have data indicators (data elements) that are organized by and will be reported at state, program, or plan levels. The blank excel workbook is available on Medicaid.gov and provides the exact indicators reported along with the instructions on how to report.  Each MCPAR report for the managed care program is provided below. 

FFY 2022 MCPAR Annual Report for Delaware Diamond State Health Plan

FFY 2023 MCPAR Annual Report for Delaware Diamond State Health Plan

 

 

Delaware submitted and received CMS approval for an 1135 Waiver to allow us to implement additional changes during the emergency declaration.

DE 1135 Flexibilities Approval Letter

The Delaware Quality Management Strategy is a comprehensive plan incorporating quality assurance monitoring and ongoing quality improvement processes to improve the delivery of quality care. The QMS covers services to members in Medicaid managed care, the Children’s Health Insurance Program, and Medicaid Long Term Care and community-based services. The QMS is the framework through which the State shares its objectives and strategies to address health care costs, quality and timely access in a collaborative approach with its partners and stakeholders. DMMA has reorganized the QMS for 2014. While the 2012 QMS strategies remain the same, the format has been changed slightly in some parts of the document to create an easier flow of information for interested users.

Diamond State Health Plan - Plus (DSHP - Plus)

The Division of Medicaid and Medical Assistance (DMMA) in partnership with the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) is developing an Integrated Long-Term Care initiative named the Diamond State Health Plan – Plus (DSHP-Plus).  This initiative will provide improved access to community-based long-term care services and increased flexibility to more effectively address individual needs, and to better control rising long-term care costs significantly impacting Medicaid.  Delaware joins many states who are implementing new models of delivering long-term care services.

Diamond State Health Plan Plus 1115 Demonstration Waiver Amendment

Public notice of DMMA's intent to submit a waiver amendment for the Diamond State Health Plan Plus was published in the July 2011 Register of Regulations (found at the following link regulations.delaware.gov/services/current_issue.shtml.  To view the full waiver amendment, click on the link to "DSHP Plus Waiver Amendment" below.  Please note that the period for comment ended on August 31, 2011.

Additional Diamond State Health Plan Plus information:

• Waiver Information
  • DSHP-Plus Waiver Amendment
  • What is an 1115 Waiver?
  • Budget Neutrality Document 

  • The Division of Medicaid and Medical Assistance has reorganized the Delaware Quality Management Strategy (QMS).  Therefore, Quality Management Strategy-2014 is the same document as Quality Management Strategy-2012, except that the 2014 version has been reorganized.   The purpose of the reorganization is to create an easier flow of information to the reader.

    To accomplish this, we made the following changes.
     

    Page	Quality Management Strategy-2012	Page	Quality Management Strategy-2014
    12	Quality Management Structure	11	Quality Management Structure—Different appearance
    17-20	Goals and Objectives	16-24	Goals and Objectives
    27	Performance Measures…Refers to phasing in the CHIPRA Pediatric Core Quality Measurement set	64	This information is now located on this page and references Appendix B & C.  Appendix B (Children) & C (Adults) are the actual measures and found on pages 80 & 81.
    72-75	Goal related HEDIS measures	16-24	Moved to and combined with goals and objectives on pages 16-24

• Program Planning
  • DSHP-Plus Concept Paper
• Provider Information Communication Tools
  • DSHP-Plus Communication PowerPoint
  • DSHP-Plus Questions and Answers
  • DSHP-Plus Brochure
• Client Notices
  • DSHP Plus November Client Notice
  • DSHP Plus December Enrollment Packets Letter
  • DSHP Plus Enrollment Letter
  • DSHP Plus Managed Care Reminder Letter
  • DSHP Plus Managed Care Confirmation Letter

For healthcare enrollment call the Health Benefit Manager (HBM) at 1-800-996-9969

For information about PACE - Programs of All-Inclusive Care for the Elderly.

For questions regarding Diamond State Health Plan - Plus (DSHP - Plus), please email Dhss_dmma_dshp_plus@delaware.gov