Common use of OUTCOMES, QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT Clause in Contracts

OUTCOMES, QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT. 2.8.1. For all covered services, the Contractor shall maintain an outcomes, quality assessment and performance improvement program that complies with 42 C.F.R. Section 438.200. 2.8.2. The Contractor shall monitor its providers’ performances on an ongoing basis and hold them accountable to a formal review according to a periodic schedule. The formal review shall be consistent with industry standards or State MCO laws and regulations. 2.8.2.1. The Contractor may use standard sampling and problem-provider targeting to maintain and improve Provider performance. 2.8.3. The Contractor shall allow the Department or its designee to conduct surveys, reviews, and audits of providers in the Contractor’s network at any time to ensure quality services are being provided to Members and contractual requirements or federal and state rules and regulations are being followed.

OUTCOMES, QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT. 2.8.1. For all covered services, the Contractor shall maintain an outcomes, quality assessment and performance improvement program that complies with 42 C.F.R. Section 438.200. 2.8.2. The Contractor shall monitor its providers’ performances performance on an ongoing basis and hold them accountable to a formal review according to a periodic schedule. The formal review shall be consistent with industry standards or State MCO managed care laws and regulations. 2.8.2.1. The Contractor may use standard sampling and problem-provider targeting to maintain and improve Provider performance. 2.8.3. The Contractor shall allow the Department or its designee to conduct surveys, reviews, and audits of providers in the Contractor’s network at any time to ensure quality services are being provided to Members and contractual requirements or federal and state rules and regulations are being followed.