their performance measures, the specifications to be followed in calculating the measures, and the method and timing that health plans must use for reporting.11

State Children’s Health Insurance Program

Congress established the SCHIP program in 1997 for low-income uninsured children. As of 2002, most states had operated their programs for only 3 or 4 years. As a consequence, both the federal and state focus for SCHIP has been on enrolling eligible children and making the program operational. More recently, attention has turned to assessing the program’s efforts (Henneberry, 2001).

SCHIP regulations require states to establish performance goals and performance measures, including a written assurance that the state will collect and maintain data and furnish reports to the Health and Human Services Secretary. Managed care is the dominant delivery system used by SCHIP programs, and the regulations grant CMS the authority to mandate standardized performance measures for managed care plans serving SCHIP enrollees (but not for FFS providers). No specific performance measures or goals are required.

Many states require managed care plans that serve SCHIP enrollees to report HEDIS measures (Henneberry, 2001). However, surveys of SCHIP programs indicate that the programs often modify HEDIS to tailor data collection to their specific program needs thus making state-to-state comparisons problematic (French and Miele, 2001). Some states are also adapting HEDIS for FFS and primary care case management. Other states have developed their own performance measures. Wisconsin, for example, is developing a new performance measurement system, the “Medicaid Encounter Data Driven Improvement Core-Measure Set,” drawing directly from monthly HMO encounter data (Henneberry, 2001).

CMS and AHRQ are currently collaborating on a Performance Measurement Partnership Project with state Medicaid and SCHIP programs to determine the feasibility of implementing a core set of standardized performance measures, such as HEDIS or CAHPS, for managed care in Medicaid and SCHIP. One aim of the project is to motivate benchmarking and state creativity in using performance measures (Block, 2002).


States may choose to develop their own measures or use standardized measures from HEDIS, FACCT, AHRQ’s CONQUEST database, or the measures recommended in A Guide for States to Assist in the Collection and Analysis of Medicaid Managed Care (MEDSTAT, 1998).

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