MA Quality Improvement (QI) Program

All Medicare Advantage (MA) organizations are required to have a quality improvement (QI) program as described in the federal regulations at 42 CFR 422.152, “Quality improvement program”. The requirements for the Prescription Drug Plan (PDP) Quality Assurance program are described at 42 CFR 423.153(c).

The primary goal of the MA organization’s QI program is to effect sustained improvement in patient health outcomes.  As provided under 42 CFR 422.152(c), an MA organization’s QI program must include a chronic care improvement program (CCIP).  The QI program must also include a health information system to collect, analyze, and report Medicare Parts C & D quality performance data, including Healthcare Effectiveness Data and Information Set (HEDIS®), Health Outcomes Survey (HOS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) data.