CalOptima QMI Program. County acknowledges and agrees that CalOptima is accountable for the quality of care furnished to its Members in all settings including services furnished by County Associates. County agrees that it is subject to the requirements of CalOptima’s QMI Program and that it shall participate in QMI Program activities as required by CalOptima. Such activities may include, but are not limited to, the provision of requested data and the participation in assessment and performance audits and projects (including those required by CalOptima’s regulators) that support CalOptima’s efforts to measure, continuously monitor, and evaluate the quality of items and services furnished to Members. County shall participate in CalOptima’s QMI Program development and implementation for the purpose of collecting and studying data reflecting clinical status and quality of life outcomes for CalOptima Members. County shall cooperate with CalOptima and Government Agencies in any complaint, appeal or other review of LHA Services (e.g., medical necessity) and shall accept as final all decisions regarding disputes over LHA Services by CalOptima or such Government Agencies, as applicable, and as required under the applicable CalOptima Program.
CalOptima QMI Program. County acknowledges and agrees that CalOptima is accountable for the quality of care furnished to its Members in all settings including services furnished by County Associates. County agrees that it is subject to the requirements of CalOptima’s QMI Program and that it shall participate in QMI Program activities as required by CalOptima. Such activities may include, but are not limited to, the provision of requested data and the participation in assessment and performance audits and projects (including those required by CalOptima’s regulators) that support CalOptima’s efforts to measure, continuously monitor, and evaluate the quality of items and services furnished to Members. County shall participate in CalOptima’s QMI Program development and implementation for the purpose of collecting and studying data reflecting clinical status and quality of life outcomes for CalOptima Members. County shall cooperate with CalOptima and Government Agencies in any complaint, appeal or other review of Behavioral Health Services (e.g., medical necessity) and shall accept as final all decisions regarding disputes over Behavioral Health Services by CalOptima or such Government Agencies, as applicable, and as required under the applicable CalOptima Program. County shall allow CalOptima to use performance data for CalOptima’s quality improvement program activities and mandatory performance data reporting to CalOptima’s Regulators.
