QAPI STRATEGIC PLAN AND UTILIZATION MANAGEMENT Sample Clauses

QAPI STRATEGIC PLAN AND UTILIZATION MANAGEMENT. 8.1 QUALITY ASSESSMENT & PERFORMANCE IMPROVEMENT (QAPI) STRATEGIC PLAN 8.1.1 The PASSE must establish and implement an ongoing Comprehensive Quality Assessment and Performance Improvement (QAPI) Strategic Plan for the services it furnishes to its enrolled members. The QAPI must include: 8.1.2 Performance Improvement Projects (PIP)—These are specific projects designed to increase the quality of services to enrolled members. Unless otherwise directed by DHS in its quality plan, the PIP must be designed to improve the results of a quarterly quality metric where the PASSE was deficient or lagging, including HEDIS® measures. a. Each PIP must: i. Be designed to achieve significant improvement, sustained over time, in health outcomes and member satisfaction. ii. Include measurement of performance using objective quality indicators. iii. Implement interventions to achieve improvement in the access to and quality of care. iv. Evaluate the effectiveness of the interventions based on the performance measures collected as part of the PIP. v. Include planning and initiation of activities for increasing or sustaining improvement. b. The PIP must address: i. the collection and submission of performance measurement data, including any required by DHS or CMS. ii. Mechanisms to detect both underutilization and overutilization of services. iii. Mechanisms to assess the quality and appropriateness of care furnished to enrolled members with special health care needs, as defined by the state in the quality strategy. iv. Mechanisms to assess the quality and appropriateness of care furnished to members using LTSS, including: a) An assessment of care between care settings; and b) A comparison of services and supports received with those set forth in the enrolled member’s PCSP. v. Participation in DHS’s efforts to prevent, detect, and remediate critical incidents, consistent with assuring the health and welfare of the enrolled member, that are based on the requirements for home and community- based waiver programs. 8.1.3 The PASSE is encouraged to utilize Provider Incentive Plans to make incentive payments to providers under the Provider Contract that are based on value. a. Incentive payments cannot be based on volume to increase inappropriate utilization (including denial of services) are not allowed. b. The incentive payment may not condition provider participation in the PASSE network on the provider entering into or adhering to intergovernmental transfer agreements. c. Provider...
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QAPI STRATEGIC PLAN AND UTILIZATION MANAGEMENT. 8.1 QUALITY ASSESSMENT & PERFORMANCE IMPROVEMENT (QAPI) STRATEGIC PLAN 8.1.1 The PASSE must establish and implement an ongoing Comprehensive Quality Assessment and Performance Improvement Strategic Plan for the services it furnishes to its Enrolled Members by March 1, 2021 for the 2021 calendar year. The Strategic Plan must include (1) improving the coordination of care with state agencies and non-medical service providers who also serve them; (2) improving training of care coordinators; (3) improving internal coordination between care coordination and utilization management; (4) expanding access by recruiting and enrolling more providers that specialize in their care; (5) implement an Adverse Childhood Experience (ACE) assessment; and (6) increasing their access to appropriate services for the following urgent needs populations: a. Children (aged 0-9) with 2 or more Adverse Childhood Experiences and youth (10-18) with 3 or more ACEs. Consider the following in ACE: i. Extended period (>2years) in poverty ii. Toxic stress iii. Caregiver alcohol or drug abuse iv. History of child maltreatment – Victim and/or offender
QAPI STRATEGIC PLAN AND UTILIZATION MANAGEMENT. 8.1 Quality Assessment and Performance Improvement (QAPI) Strategic Plan 8.1.1 The DMO must establish and implement a Quality Assessment and Performance Improvement (QAPI) Strategic Plan for the services it furnishes to Enrolled Members. The QAPI, and any amendments thereto, must be approved by DHS prior to implementation, and must meet the requirements of the Agreement and 42 CFR § 438.330. 8.2 Performance Improvement Projects (PIPs) 8.2.1 Each PIP must: a. Be designed to achieve significant improvement, sustained over time, in dental health outcomes and/or Enrolled Member satisfaction; b. Include measurements of performance using objective quality indicators; c. Implement interventions to achieve improvement in the access to and quality of care; d. Evaluate the effectiveness of the interventions based on the performance measures collected; e. Include planning and initiation of activities for increasing or sustaining improvement. 8.2.2 The PIP must address: a. The collection and submission of performance measurement data, including any required by CMS or DHS; b. The mechanisms to detect both under and over-utilization of services; and c. Mechanisms to assess the quality and appropriateness of care furnished to Enrolled Members with special health care needs, as defined by the state in the quality strategy.

Related to QAPI STRATEGIC PLAN AND UTILIZATION MANAGEMENT

  • Utilization Management Contractor shall maintain a utilization management program that complies with applicable laws, rules and regulations, including Health and Safety Code § 1367.01 and other requirements established by the applicable State Regulators responsible for oversight of Contractor.

  • STRATEGIC PLAN (1) Within one hundred twenty (120) days, the Board shall adopt, implement, and thereafter ensure Bank adherence to a written strategic plan for the Bank covering at least a three-year period. The strategic plan shall establish objectives for the Bank's overall risk profile, earnings performance, growth, balance sheet mix, off-balance sheet activities, liability structure, capital adequacy, reduction in the volume of nonperforming assets, product line development and market segments that the Bank intends to promote or develop, together with strategies to achieve those objectives and, at a minimum, include: (a) a mission statement that forms the framework for the establishment of strategic goals and objectives; (b) an assessment of the Bank's present and future operating environment; (c) the development of strategic goals and objectives to be accomplished over the short and long term; (d) an identification of the Bank’s present and future product lines (assets and liabilities) that will be utilized to accomplish the strategic goals and objectives established in (1 )(c) of this Article; (e) an evaluation of the Bank's internal operations, staffing requirements, board and management information systems and policies and procedures for their adequacy and contribution to the accomplishment of the goals and objectives developed under (1)(c) of this Article; (f) a management employment and succession program to promote the retention and continuity of capable management; (g) product line development and market segments that the Bank intends to promote or develop; (h) an action plan to improve bank earnings and accomplish identified strategic goals and objectives, including individual responsibilities, accountability and specific time frames; (i) a financial forecast to include projections for major balance sheet and income statement accounts and desired financial ratios over the period covered by the strategic plan; (j) control systems to mitigate risks associated with planned new products, growth, or any proposed changes in the Bank’s operating environment; (k) specific plans to establish responsibilities and accountability for the strategic planning process, new products, growth goals, or proposed changes in the Bank’s operating environment; and (l) systems to monitor the Bank’s progress in meeting the plan’s goals and objectives. (2) Upon adoption, a copy of the plan shall be forwarded to the Assistant Deputy Comptroller for review and prior written determination of no supervisory objection. Upon receiving a determination of no supervisory objection from the Assistant Deputy Comptroller, the Bank shall implement and adhere to the strategic plan. (3) The Board shall ensure that the Bank has processes, personnel, and control systems to ensure implementation of and adherence to the plan developed pursuant to this Article.

  • Program Management 1.1.01 Implement and operate an Immunization Program as a Responsible Entity 1.1.02 Identify at least one individual to act as the program contact in the following areas: 1. Immunization Program Manager;

  • Performance Management 17.1 The Contractor will appoint a suitable Account Manager to liaise with the Authority’s Strategic Contract Manager. Any/all changes to the terms and conditions of the Agreement will be agreed in writing between the Authority’s Strategic Contract Manager and the Contractor’s appointed representative. 17.2 The Contractor will ensure that there will be dedicated resources to enable the smooth running of the Framework Agreement and a clear plan of contacts at various levels within the Contractor's organisation. Framework Public Bodies may look to migrate to this Framework Agreement as and when their current contractual arrangements expire. The Contractor will where necessary assign additional personnel to this Framework Agreement to ensure agreed service levels are maintained and to ensure a consistent level of service is delivered to all Framework Public Bodies. 17.3 In addition to annual meetings with the Authority's Strategic Contract Manager, the Contractor is expected to develop relationships with nominated individuals within each of the Framework Public Bodies to ensure that the level of service provided on a local basis is satisfactory. Where specific problems are identified locally, the Contractor will attempt to resolve such problems with the nominated individual within that organisation. The Authority's Strategic Contract Manager will liaise (or meet as appropriate) regularly with the Framework Public Bodies' Contract Manager, and where common problems are identified, it will be the responsibility of the Contractor to liaise with the Authority's Strategic Contract Manager to agree a satisfactory course of action. Where the Contractor becomes aware of a trend that would have a negative effect on one or more of the Framework Public Bodies, they should immediately notify the Authority's Strategic Contract Manager to discuss corrective action. 17.4 Regular meetings, frequency to be advised by Framework Public Body, will be held between the Framework Public Bodies' Contract Manager and the Contractor's representative to review the performance of their Call-Off Contract(s) under this Framework Agreement against the agreed service levels as measured through Key Performance Indicators (KPIs). Reports will be provided by the Contractor to the Framework Public Bodies' Contract Manager at least 14 days prior to the these meetings. 17.5 Performance review meetings will also be held annually, between the Authority's Strategic Contract Manager and the Contractor's representative to review the performance of the Framework Agreement against the agreed service levels as measured through Key Performance Indicators. A summary of the quarterly reports will be provided by the Contractor at least 14 days prior to these meetings. 17.6 The Authority will gather the outputs from contract management to review under the areas detailed in the table below. Provision of management reports 90% to be submitted within 10 working days of the month end Report any incident affecting the delivery of the Service(s) to the Framework Public Body 100% to be reported in writing to FPB within 24 hours of the incident being reported by telephone/email Prompt payment of sub-contractors and/or consortia members (if applicable). Maximum of 30 from receipt of payment from Framework Public Bodies, 10 days target 100% within 30 days

  • Project Management Plan 3.2.1 Developer is responsible for all quality assurance and quality control activities necessary to manage the Work, including the Utility Adjustment Work. Developer shall undertake all aspects of quality assurance and quality control for the Project and Work in accordance with the approved Project Management Plan, Good Industry Practice and applicable Law. 3.2.2 Developer shall develop the Project Management Plan and its component parts, plans and other documentation in accordance with the requirements set forth in Section 1.5.2.5

  • Project Management Project Management Institute (PMI) certified project manager executing any or all of the following: • Development of Project Charter • Development of project plan and schedule • Coordination and scheduling of project activities across customer and functional areas • Consultation on operational and infrastructure requirements, standards and configurations • Facilitate project status meetings • Timely project status reporting • Address project issues with functional areas and management • Escalation of significant issues to customers and executive management • Manage project scope and deliverable requirements • Document changes to project scope and schedule • Facilitate and document project closeout

  • PERFORMANCE MANAGEMENT SYSTEM 6.1 The Performance Plan (Annexure A) to this Agreement sets out – 6.1.1 The standards and procedures for evaluating the Employee’s performance; and 6.1.2 The intervals for the evaluation of the Employee’s performance. 6.2 Despite the establishment of agreed intervals for evaluation, the Employer may in addition review the Employee’s performance at any stage while the contract of employment remains in force; 6.3 Personal growth and development needs identified during any performance review discussion must be documented in a Personal Development Plan as well as the actions agreed to and implementation must take place within set time frames; 6.4 The Employee’s performance will be measured in terms of contributions to the goals and strategies set out in the Employer’s Integrated Development Plan (IDP) as described in 6.6 – 6.12 below; 6.5 The Employee will submit quarterly performance reports (SDBIP) and a comprehensive annual performance report at least one week prior to the performance assessment meetings to the Evaluation Panel Chairperson for distribution to the panel members for preparation purposes; 6.6 Assessment of the achievement of results as outlined in the performance plan: 6.6.1 Each KPI or group of KPIs shall be assessed according to the extent to which the specified standards or performance targets have been met and with due regard to ad-hoc tasks that had to be performed under the KPI, and the score of the employer will be given to and explained to the Employee during the assessment interview. 6.6.2 A rating on the five-point scale shall be provided for each KPI or group of KPIs which will then be multiplied by the weighting to calculate the final score; 6.6.3 The Employee will submit his self-evaluation to the Employer prior to the formal assessment; 6.6.4 In the instance where the employee could not perform due to reasons outside the control of the employer and employee, the KPI will not be considered during the evaluation. The employee should provide sufficient evidence in such instances; and 6.6.5 An overall score will be calculated based on the total of the individual scores calculated above.

  • Change Management BellSouth provides a collaborative process for change management of the electronic interfaces through the Change Control Process (CCP). Guidelines for this process are set forth in the CCP document as amended from time to time during this Agreement. The CCP document may be accessed via the Internet at xxxx://xxx.xxxxxxxxxxxxxxx.xxxxxxxxx.xxx.

  • Quality Management Grantee will: 1. comply with quality management requirements as directed by the System Agency. 2. develop and implement a Quality Management Plan (QMP) that conforms with 25 TAC § 448.504 and make the QMP available to System Agency upon request. The QMP must be developed no later than the end of the first quarter of the Contract term. 3. update and revise the QMP each biennium or sooner, if necessary. Xxxxxxx’s governing body will review and approve the initial QMP, within the first quarter of the Contract term, and each updated and revised QMP thereafter. The QMP must describe Xxxxxxx’s methods to measure, assess, and improve - i. Implementation of evidence-based practices, programs and research-based approaches to service delivery; ii. Client/participant satisfaction with the services provided by Xxxxxxx; iii. Service capacity and access to services; iv. Client/participant continuum of care; and v. Accuracy of data reported to the state. 4. participate in continuous quality improvement (CQI) activities as defined and scheduled by the state including, but not limited to data verification, performing self-reviews; submitting self-review results and supporting documentation for the state’s desk reviews; and participating in the state’s onsite or desk reviews. 5. submit plan of improvement or corrective action plan and supporting documentation as requested by System Agency. 6. participate in and actively pursue CQI activities that support performance and outcomes improvement. 7. respond to consultation recommendations by System Agency, which may include, but are not limited to the following: i. Staff training; ii. Self-monitoring activities guided by System Agency, including use of quality management tools to self-identify compliance issues; and iii. Monitoring of performance reports in the System Agency electronic clinical management system.

  • MANAGEMENT OF EVALUATION OUTCOMES 12.1 Where the Employer is, any time during the Employee’s employment, not satisfied with the Employee’s performance with respect to any matter dealt with in this Agreement, the Employer will give notice to the Employee to attend a meeting; 12.2 The Employee will have the opportunity at the meeting to satisfy the Employer of the measures being taken to ensure that his performance becomes satisfactory and any programme, including any dates, for implementing these measures; 12.3 Where there is a dispute or difference as to the performance of the Employee under this Agreement, the Parties will confer with a view to resolving the dispute or difference; and 12.4 In the case of unacceptable performance, the Employer shall – 12.4.1 Provide systematic remedial or developmental support to assist the Employee to improve his performance; and 12.4.2 After appropriate performance counselling and having provided the necessary guidance and/or support as well as reasonable time for improvement in performance, the Employer may consider steps to terminate the contract of employment of the Employee on grounds of unfitness or incapacity to carry out his or her duties.

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