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Quality Management


Five Star Rating Report

HFS has created a new Five-Star Quality Rating Report to help consumers, their families, and caregivers compare managed care organizations (MCOs) by topics they consider as most important. The HFS website features a star rating report that assigns each managed care organization (MCO) ratings from 1 to 5 stars.  Managed care organizations (MCOs) with 5 stars are considered to have much above average quality and managed care organizations (MCOs) with 1 star are considered to have quality below average.  There is an Overall 5-star rating for each managed care organization (MCO) and a separate rating for each of the areas of information.

HFS uses the Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance by the MCOs. More than 90 percent of America's health plans use the Healthcare Effectiveness Data and Information Set (HEDIS) to measure performance on important components of care. Because so many plans collect HEDIS data and the measures are so specifically defined, HEDIS makes it possible to compare the performance of health plans on an "apples-to-apples" basis. With this first rollout, the star rating report compares MCOs for the elderly and individuals with disabilities enrolled in the Integrated Care Program (ICP).  By the end of the year, the star rating report will be available for most Medicaid programs.

We welcome comments and feedback on this report.

HFS oversees quality measurement and improvement projects and evaluates and reports on the quality of healthcare and care coordination for our clients in Illinois.  HFS is committed to providing quality health services through an integrated and coordinated delivery system that promotes and focuses on health outcomes, cost controls, accessibility to providers, accountability, and customer satisfaction

Care Coordination

HFS plays a critical role overseeing the quality of care and medical services delivered to the Medicaid populations of Illinois. Through:

  1. Health care providers who coordinate and deliver health care and medical services to Medicaid populations

  2. National quality metrics from the Healthcare Effectiveness and Information Data Set (HEDIS) to evaluate outcomes of care.

  3. Assessment satisfaction with the services provided, through the Consumer Assessment of Health Plans Survey (CAHPS)

Home & Community Based Services

  1. Oversees in quality improvement system development and enhancement for Illinois’ nine Home and Community-Based Services (HCBS) waiver programs.

  2. Collaboration with the state agencies HFS submits reports to the federal government on performance results of Waiver services.   

For more information on these services click here.

Women’s Health

HFS provides coverage for over 50 percent of the State’s births and about 92 percent of births to teens; therefore, improving birth outcomes continues to be one of the Department’s highest priorities.

HFS’ comprehensive approach includes the following Quality Improvement Initiatives:  

  1. Family Planning – identify best practices to increase access to comprehensive quality family planning services.

  2. Reproductive/Women’s Health – inform providers to promote quality well-women care, promoting the importance of reproductive life planning, and addressing preventive care interventions to reduce disparities

  3. Pregnancy/Maternal Health – Inform evidence-based standards of care.

More information about these initiatives and available services is provided in the resources below:

  1. Perinatal Report to the General Assembly

  2. HFS Handbook for Practitioners – Section A-223: Family Planning, Reproductive Health & Pregnancy/Maternal

  3. HFS Handbook for Providers of Healthy Kids Services – Section HK-203.9.2: Perinatal Depression

  4. Illinois Healthy Women Final Evaluation Report

  5. HFS Notice on Perinatal Depression

Child Health

The Child Health program oversees components of the Early and Periodic Screening, Diagnosis and
Treatment (EPSDT) program.  EPSDT is the nation’s largest preventive child health initiative, to which children enrolled in Medicaid are entitled. Child health quality improvement activities can be found below:   

More information about services available to children is available in the Handbook for Providers of Healthy Kids Services and on the Maternal and Child Health web page.

  1. Early Intervention Care Coordination Provider Toolkit – To help providers initiate referrals to Early Intervention (EI) for children with suspected developmental delay through the use of a Standardized Illinois Early Intervention Referral Form.

  2. BMI Assessment and Obesity-related Weight Management Follow-up - This notice includes recommendations for follow-up care and describes payment policy.

  3. Text4baby – A free mobile texting service designed to improve maternal and child health.

Quality Reporting

Data collection, analysis and reporting are key components of measuring the impacts of programmatic and quality improvement efforts over time.  HFS’ Child Health program is responsible for reporting annually to the federal Centers for Medicare and Medicaid Services (CMS) on the EPSDT program by submitting the CMS-416 Reporting of EPSDT Services for Children and the Children’s Health Insurance Program (CHIP) Annual Report of the CMS Child Core Set measures. The Child Health program also reports to federal CMS on the Adult Core Measures. 

Available reports are listed below:

  1. Maternal and Child Health Program

  2. Peer Review Organization (PRO) / Quality Improvement Organization (QIO)

  3. Illinois Family Planning

  4. Early Intervention Care Coordination Provider Toolkit

  5. Home and Community Based Services Waiver Programs









Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director