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, 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 the 2020 Reporting Year, New York State is presenting ATR reports on three (3) Medicaid product lines: Medicaid Managed Care, HIV Special Needs Plan (HIV SNP), and Health and Recovery Plan (HARP). 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 2020 External Quality Review (EQR), conducted by New York State's External Quality Review Organization (EQRO), Island Peer Review Organization (IPRO).

These reports are organized in the following manner: Purpose and Scope; Background and History of the NYS MMC program; New York State Medicaid Quality Strategy; Recommendations to the New York State Department of Health; External Quality Review Activities; Corporate Profiles; Findings and Conclusions Related to Quality, Timeliness and Access, which includes Validation of Performance Improvement Projects, Validation of Performance Measures, and Review of Compliance with Medicaid and CHIP Managed Care Regulations; Managed Care Plan (MCP)-Level Reporting; and, NYS Quality Assurance Reporting Requirements (QARR). Although the reports focus primarily on Medicaid data, selected sections of these reports also include data from the plans' Commercial and Child Health Plus product lines. Additionally, when available and appropriate, the plans' data are compared with statewide benchmarks. When benchmarks are utilized for rates other than QARR, comparative statements 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.

Section VI - MCP-Level Reporting, provides an assessment of the MCP’s 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 is appended to this section of the 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 2020.

Reporting Year 2020

Reporting Year 2019

Reporting Year 2018