Annual External Quality Review Technical Report - New York State Department of Health

New York State (NYS) is dedicated to providing and maintaining the highest quality of care for Medicaid and Child Health Plus enrollees in managed health care plans. The New York State Department of Health (NYSDOH) Office of Health Insurance Programs (OHIP), and the Office of Health Services Quality and Analytics (OHSQA), employ an ongoing strategy to improve the quality of care provided to plan enrollees, to ensure the accountability of these plans, and maintain the continuity of care to the public.

The External Quality Review Annual Technical Report (ATR) aggregates, analyzes, and evaluates information on the quality, timeliness, and access to healthcare services that managed care plans (MCP) furnish to Medicaid and Child Health Plus enrollees.

For this reporting year, New York State presents two reports containing information on four (4) Medicaid product lines and the Child Health Plus program. The first report includes mainstream Medicaid managed care and Child Health Plus (MMC/CHPlus, 12 MCPs), HIV Special Needs Plans (HIV SNP, 3 MCPs), and Health and Recovery Plans (HARP, 11 MCPs). The second report contains Managed Long-Term Care (MLTC) plans certified to provide Medicaid coverage in New York State, which includes Medicaid Advantage Plus (MAP, 12 MCPs), Partial Capitation (25 MCPs), and Program of All-Inclusive Care for the Elderly (PACE, 9 MCPs). New for the 2022 reporting year, the MMC/CHPlus, HIV SNP, and HARP results have been combined into one report.

In accordance with federal requirements, these reports summarize the results of the 2022 External Quality Review (EQR) conducted by New York State's External Quality Review Organization (EQRO), Island Peer Review Organization (IPRO).

Each report summarizes the External Quality Review Activities including:

  • Validation of Performance Improvement Projects
  • Validation of Performance Measures
  • Review of Compliance with Medicaid and Children's Health Insurance Program Standards
  • Administration of Quality-of-Care Surveys

Each report also includes an MCP-specific section that provides an assessment of the MCPs strengths and opportunities for improvement in the areas of quality, timeliness, and accessibility of services. For areas in which the plan has opportunities for improvement, recommendations are provided for improving the quality of health care services. To achieve full compliance with federal regulations, this section also includes an assessment of the degree to which each MCP has effectively addressed the recommendations for quality improvement made by the NYS EQRO in the previous year's EQR report. MCPs were given the opportunity to describe current and proposed interventions that address areas of concern, as well as an opportunity to explain areas that the MCP did not feel were within its ability to improve. The response by the MCP to the previous year's recommendations is appended to the MCP-specific section of the report. The response by each MCP to the 2022 recommendations will be included in the 2023 ATR.

In an effort to provide the most consistent presentation of this varied information, the ATR is prepared based on data for the most current calendar year available. Where possible, data for prior calendar years may also be included for trending purposes. Additionally, when available and appropriate, MCP data are compared with statewide and national benchmarks. This report includes data for Reporting Year 2022.

Reporting Year 2022

Reporting Year 2021

Reporting Year 2020