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 enrollees in managed health care plans. The New York State Department of Health (NYSDOH) Office of Health Insurance Programs (OHIP), and the Office of Quality and Patient Safety (OQPS), 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 recipients. For this reporting year, New York State is presenting reports on four (4) Medicaid product lines: Medicaid Managed care, HIV Special Needs Plans (HIV SNP), Health and Recovery Plan (HARP), and new this year, Managed Long-Term Care (MLTC). The Medicaid Managed Care ATR is a report of thirteen (13) MCPs; the Medicaid Managed Care HIV SNP ATR is a report of three (3) MCPs; the HARP ATR is a report of twelve (12) MCPs. In accordance with federal requirements, these reports summarize the results of the 2021 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

Although the reports focus primarily on Medicaid data, selected sections of these reports also include data from the plans’ Child Health Plus product lines. Additionally, when available and appropriate, the plans’ data are compared with statewide and national benchmarks. Statistical comparisons are based on differences determined by standard deviations: a difference of one standard deviation is used to determine rates that are higher or lower than the statewide average.

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 the MCP has effectively addressed the recommendations for quality improvement made by the NYS EQRO in the previous year’s EQR report. The MCP was 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 this section of the report.

Reporting year 2021 is the first year the MLTC plans have been included in the ATR. The ATR is an aggregate report on the External Quality Review activities conducted with the MLTC plans certified to provide Medicaid coverage in NYS. Included in the report are Medicaid Advantage Plus (MAP), Partial Capitation, and Program of All-Inclusive Care for the Elderly (PACE). In 2021, there were 13 approved MAP plans managed care plans, 25 Partial Capitation managed care plans, and 9 PACE managed care plans. As with the other Medicaid ATR, the MCP-specific section provides an assessment of the MCP 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 by the EQRO for improving the quality of health care services. This report will be published and distributed to the MCP’s to provide an opportunity to respond to these recommendations. The responses received to the 2021 recommendations will be included in the 2022 MLTC Annual Technical Report.

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. This report includes data for Reporting Year 2021.

Reporting Year 2021

Reporting Year 2020

Reporting Year 2019