Common use of Quality Assessment and Performance Improvement Clause in Contracts

Quality Assessment and Performance Improvement. A. The Contractor shall implement an ongoing comprehensive Quality Assessment and Performance Improvement (QAPI) Program for the services it furnishes to beneficiaries. (42 C.F.R. § 438.330 (a).) B. The Contractor’s QAPI Program shall improve the Contractor’s established outcomes through structural and operational processes and activities that are consistent with current standards of practice. C. The Contractor shall have a written description of the QAPI Program that clearly defines the QAPI Program’s structure and elements, assigns responsibility to appropriate individuals, and adopts or establishes quantitative measures to assess performance and to identify and prioritize area(s) for improvement. The Contractor shall evaluate the impact and effectiveness of its QAPI Program annually and update the Program as necessary per Cal. Code Regs., tit. 9, § 1810.440(a)(6). (42 C.F.R. § 438.330(e)(2).) D. The QAPI Program shall include collection and submission of performance measurement data required by the Department, which may include performance measures specified by CMS. The Contractor shall measure and annually report to the Department its performance, using the standard measures identified by the Department. (42 C.F.R. § 438.330 (a)(2), (b)(2), (c)(2).) E. The Contractor shall conduct performance monitoring activities throughout the Contractor’s operations. These activities shall include, but not be limited to, beneficiary and system outcomes, utilization management, utilization review, provider appeals, credentialing and monitoring, and resolution of beneficiary grievances. F. The Contractor shall have mechanisms to detect both underutilization of services and overutilization of services. (42 C.F.R. § 438.330(b)(3).)

Quality Assessment and Performance Improvement. A. The Contractor shall implement an ongoing comprehensive Quality Assessment and Performance Improvement (QAPI) Program for the services it furnishes to beneficiaries. (42 C.F.R. § 438.330 (a).) B. The Contractor’s QAPI Program shall improve the Contractor’s established outcomes through structural and operational processes and activities that are consistent with current standards of practice. C. The Contractor shall have a written description of the QAPI Program that clearly defines the QAPI Program’s structure and elements, assigns responsibility to appropriate individuals, and adopts or establishes quantitative measures to assess performance and to identify and prioritize area(s) for improvement. The Contractor shall evaluate the impact and effectiveness of its QAPI Program annually and update the Program as necessary per Cal. Code Regs., tit. 9, § 1810.440(a)(6). (42 C.F.R. § 438.330(e)(2).) D. The QAPI Program shall include collection and submission of performance measurement data required by the Department, which may include performance measures specified by CMS. The Contractor shall measure and annually report to the Department its performance, using the standard measures identified by the Department. (42 C.F.R. § 438.330 (a)(2), (b)(2), (c)(2).) E. The Contractor shall conduct performance monitoring activities throughout the Contractor’s operations. These activities shall include, but not be limited to, beneficiary and system outcomes, utilization management, utilization review, provider appeals, credentialing and monitoring, and resolution of beneficiary grievances. F. The Contractor shall have mechanisms to detect both underutilization of services and overutilization of services. (42 C.F.R. § 438.330(b)(3).) G. The Contractor shall implement mechanisms to assess beneficiary/family satisfaction. The Contractor shall assess beneficiary/family satisfaction by: 1) Surveying beneficiary/family satisfaction with the Contractor’s services at least annually; 2) Evaluating beneficiary grievances, appeals and fair hearings at least annually; and 3) Evaluating requests to change persons providing services at least annually. 4) The Contractor shall inform providers of the results of beneficiary/family satisfaction activities. H. The Contractor shall implement mechanisms to monitor the safety and effectiveness of medication practices. The monitoring mechanism shall be under the supervision of a person licensed to prescribe or dispense prescription drugs. Monitoring shall occur at least annually. I. The Contractor shall implement mechanisms to address meaningful clinical issues affecting beneficiaries system-wide. J. The Contractor shall implement mechanisms to monitor appropriate and timely intervention of occurrences that raise quality of care concerns. The Contractor shall take appropriate follow-up action when such an occurrence is identified. The results of the intervention shall be evaluated by the Contractor at least annually. K. Contractor’s QAPI Program shall include Performance Improvement Projects as specified in paragraph 5.