Common use of Internal Quality Assurance Program Clause in Contracts

Internal Quality Assurance Program. a) Contractor must operate a quality assurance program which is approved by SDOH and which includes methods and procedures to control the utilization of Medicaid services consistent with PHL Article 49 and 42 CFR Part 456. Recipients' records must include information needed to perform utilization review as specified in 42 CFR Sections 456.111 and 456.211. The Contractor's approved quality assurance program must be kept on file by the Contractor and the LDSS. The Contractor shall not modify the quality assurance program without the prior written approval of the SDOH, and notice to the LDSS. b) The Contractor shall incorporate the findings from reports in Section 18 of this Agreement into its quality assurance program. Where performance is less than the statewide average or another standard as defined by the SDOH and developed in consultation with plans and appropriate clinical experts, the Contractor will be required to develop and implement a plan for improving performance that is approved by the SDOH and LDSS and that specifies the expected level of improvement and timeframes for actions expected to result in such improvement. In the event that such approved plan does not result in the expected level of improvement, the Contractor shall work with the SDOH and the LDSS to develop and implement alternative plans to achieve improvement. The Contractor agrees to meet with the SDOH and LDSS to review improvement plans and quality performance.

Internal Quality Assurance Program. a) Contractor must operate a quality assurance program which is approved by SDOH and which includes methods and procedures to control the utilization of Medicaid services consistent with PHL Article 49 and 42 CFR Part 456. Recipients' records must include information needed to perform utilization review as specified in 42 CFR Sections 456.111 and 456.211. The Contractor's Contractors approved quality assurance program must be kept on file by the Contractor and the LDSS. The Contractor shall not modify the quality assurance program without the prior written approval of the SDOH, and notice to the LDSS. b) The Contractor shall incorporate the findings from reports in Section 18 of this Agreement into its quality assurance program. Where performance is less than the statewide average or another standard as defined by the SDOH and developed in consultation with plans and appropriate clinical experts, the Contractor will be required to develop and implement a plan for improving performance that is approved by the SDOH and LDSS and that specifies the expected level of improvement and timeframes for actions expected to result in such improvement. In the event that such approved plan does not result in the expected level of improvement, the Contractor shall work with the SDOH and the LDSS to develop and implement alternative plans to achieve improvement. The Contractor agrees to meet with the SDOH and LDSS to review improvement plans and quality performance.

Internal Quality Assurance Program. a) Contractor must operate a quality assurance program which is approved by SDOH SDOR and which includes methods and procedures to control the utilization of Medicaid services consistent with PHL Article 49 and 42 CFR Part 456. Recipients' records must include information needed to perform utilization review as specified in 42 CFR Sections 456.111 and 456.211. The Contractor's approved quality assurance program must be kept on file by the Contractor and the LDSS. The Contractor shall not modify the quality assurance program without the prior written approval of the SDOH, and notice to the LDSS. b) . The Contractor shall incorporate the findings from reports in Section 18 of this Agreement into its quality assurance program. Where performance is less than the statewide average or another standard as defined by the SDOH and developed in consultation with plans and appropriate clinical experts, the Contractor will be required to develop and implement a plan for improving performance that is approved by the SDOH and LDSS and that specifies the expected level of improvement and timeframes for actions expected to result in such improvement. In the event that such approved plan does not result in the expected level of improvement, the Contractor shall work with the SDOH and the LDSS to develop and implement "alternative plans to achieve improvement. The Contractor agrees to meet with the SDOH and LDSS to review improvement plans and quality performance.