Delegation of Quality Improvement Activities. A. Contractor is accountable for all quality improvement functions and responsibilities (e.g. Utilization Management, Credentialing and Site Review) that are delegated to Subcontractors. If Contractor delegates quality improvement functions, Contractor and delegated entity (Subcontractor) shall include in their Subcontract, at a minimum:
1) Quality improvement responsibilities, and specific delegated functions and activities of the Contractor and Subcontractor.
2) Contractor’s oversight, monitoring, and evaluation processes and Subcontractor’s agreement to such processes.
3) Contractor’s reporting requirements and approval processes. The agreement shall include Subcontractor’s responsibility to report findings and actions taken as a result of the Quality Improvement activities at least quarterly.
4) Contractor’s actions/remedies if Subcontractor’s obligations are not met.
B. Contractor shall maintain a system to ensure accountability for delegated Quality Improvement activities, that at a minimum:
1) Evaluates Subcontractor’s ability to perform the delegated activities including an initial review to assure that the Subcontractor has the administrative capacity, task experience, and budgetary resources to fulfill its responsibilities.
2) Ensures Subcontractor meets standards set forth by the Contractor and DHCS.
3) Includes the continuous monitoring, evaluation and approval of the delegated functions.
Delegation of Quality Improvement Activities. A. Contractor is accountable for all Quality Improvement functions and responsibilities (e.g. Utilization Management, Credentialing and site review) that are delegated to Subcontractors. If Contractor delegates Quality Improvement functions, Contractor and delegated entity (Subcontractor) shall include in their Subcontract, at minimum:
1) Quality Improvement responsibilities, and specific delegated functions and activities of the Contractor and Subcontractor.
2) Contractor’s oversight, monitoring, and evaluation processes and Subcontractor’s agreement to such processes.
3) Contractor’s reporting requirements and approval processes. The agreement shall include Subcontractor’s responsibility to report findings and actions taken as a result of the Quality Improvement activities at least quarterly.
4) Contractor’s actions/remedies if Subcontractor’s obligations are not met.
5) Contractor must ensure that corrective action(s) are taken for all deficiencies or areas for improvement identified.
B. Contractor shall maintain a system to ensure accountability for delegated Quality Improvement activities, that at a minimum:
1) Evaluates Subcontractor’s ability to perform the delegated activities including an initial review to assure that the Subcontractor has the administrative capacity, task experience, and budgetary resources to fulfill its responsibilities.
2) Ensures Subcontractor meets standards set forth by the Contractor and DHCS.
3) Includes the continuous monitoring, evaluation and approval of the delegated functions.
C. Contractor must ensure that the Subcontractor monitor performance on an ongoing basis and subject it to formal review upon the State’s request.
