Common use of QAPI Program Overview Clause in Contracts

QAPI Program Overview. The HMO must develop, maintain, and operate a quality assessment and performance improvement (QAPI) Program consistent with the Contract, and TDI requirements, including 28 T.A.C. §11.1901(a)(5) and §11.1902. Medicaid HMOs must also meet the requirements of 42 C.F.R. §438.240. The HMO must have on file with HHSC an approved plan describing its QAPI Program, including how the HMO will accomplish the activities required by this section. The HMO must submit a QAPI Program Annual Summary in a format and timeframe specified by HHSC or its designee. The HMO must keep participating physicians and other Network Providers informed about the QAPI Program and related activities. The HMO must include in Provider contracts a requirement securing cooperation with the QAPI. The HMO must approach all clinical and non-clinical aspects of quality assessment and performance improvement based on principles of Continuous Quality Improvement (CQI)/Total Quality Management (TQM) and must: 1. Evaluate performance using objective quality indicators; 2. Xxxxxx data-driven decision-making; 3. Recognize that opportunities for improvement are unlimited; 4. Solicit Member and Provider input on performance and QAPI activities; 5. Support continuous ongoing measurement of clinical and non-clinical effectiveness and Member satisfaction; 6. Support programmatic improvements of clinical and non-clinical processes based on findings from on-going measurements; and 7. Support re-measurement of effectiveness and Member satisfaction, and continued development and implementation of improvement interventions as appropriate.

QAPI Program Overview. The HMO MCO must develop, maintain, and operate a quality assessment Quality Assessment and performance improvement Performance Improvement (QAPI) Program consistent with the Contract, Contract and TDI requirements, including 28 T.A.C. §11.1901(a)(5) and §11.1902. Medicaid HMOs MCOs must also meet the requirements of 42 C.F.R. §438.240. The HMO MCO must have on file with HHSC an approved plan describing its QAPI Program, including how the HMO MCO will accomplish the activities required by this section. The HMO MCO must submit a QAPI Program Annual Summary in a format and timeframe specified by HHSC or its designee. The HMO MCO must keep participating physicians and other Network Providers informed about the QAPI Program and related activities. The HMO MCO must include in Provider contracts a requirement securing cooperation with the QAPI. The HMO MCO must approach all clinical and non-clinical aspects of quality assessment and performance improvement based on principles of Continuous Quality Improvement (CQI)/Total Quality Management (TQM) and must: 1. Evaluate evaluate performance using objective quality indicators; 2. Xxxxxx xxxxxx data-driven decision-making; 3. Recognize recognize that opportunities for improvement are unlimited; 4. Solicit solicit Member and Provider input on performance and QAPI activities; 5. Support support continuous ongoing measurement of clinical and non-clinical effectiveness and Member satisfaction; 6. Support support programmatic improvements of clinical and non-clinical processes based on findings from on-going ongoing measurements; and 7. Support support re-measurement of effectiveness and Member satisfaction, and continued development and implementation of improvement interventions as appropriate.