QI Program Structure Clause Samples

QI Program Structure. 2.11.2.1. The ICDS Plan shall maintain a well-defined QI organizational and program structure that supports the application of the principles of CQI to all aspects of the ICDS Plan’s service delivery system. The QI program must be communicated in a manner that is accessible and understandable to internal and external individuals and entities, as appropriate. The ICDS Plan’s QI organizational and program structure shall comply with all applicable provisions of 42 CFR § 438, Subpart D, Quality Assessment and Performance Improvement, 42 CFR § 422, Subpart D Quality Improvement, and shall meet the quality management and improvement criteria described in the most current NCQA Health Plan Accreditation Requirements. Specifically, the ICDS Plan shall establish procedures such that the ICDS Plan shall be able to demonstrate that it meets the requirements of the HMO Federal qualification regulations (42 C.F.R. § 417.106), the Medicare HMO/CMP regulations (42 C.F.R. § 417.418(c)), and the regulations promulgated pursuant to the Balanced Budget Act of 1997 (42 C.F.R. § 438.200 et seq.). 2.11.2.2. These regulations require that the ICDS Plan have an ongoing fully implemented Quality Program for health services and shall : 2.11.2.2.1. Establish a set of QI functions and responsibilities that are clearly defined and that are proportionate to, and adequate for, the planned number and types of QI initiatives and for the completion of QI initiatives in a competent and timely manner; 2.11.2.2.2. Ensure that such QI functions and responsibilities are assigned to individuals with the appropriate skill set to oversee and implement an organization-wide, cross-functional commitment to, and application of, CQI to all clinical and non-clinical aspects of the ICDS Plan’s service delivery system; 2.11.2.2.3. Establish internal processes to ensure that the quality program activities for primary, specialty, and behavioral health services, and LTSS reflect utilization across the Provider Network and include all of the activities in this Section of this Contract and, in addition, the following elements: 2.11.2.2.3.1. A process to utilize Healthcare Plan Effectiveness Data and Information Set (HEDIS), Care Management Program Evaluation Data, Consumer Assessment of Healthcare Providers and Services (CAHPS), the Health Outcomes Survey (HOS) and other measurement results in designing QI activities;