Quality Assessment Performance Improvement. (QAPI) Program 4.12.5.1 The Contractor shall have in place an ongoing QAPI program consistent with 42 CFR 438.240. 4.12.5.2 The Contractor’s QAPI program shall be based on the latest available research in the area of Quality assurance and at a minimum must include: · A method of monitoring, analysis, evaluation and improvement of the delivery, Quality and appropriateness of Health Care furnished to all Members (including under and over Utilization of services), including those with special Health Care needs; · Written policies and procedures for Quality assessment, Utilization Management and continuous Quality improvement that are periodically assessed for efficacy; · A health information system sufficient to support the collection, integration, tracking, analysis and reporting of data; · Designated staff with expertise in Quality assessment, Utilization Management and continuous Quality improvement; · Reports that are evaluated, indicated recommendations that are implemented, and feedback provided to Providers and Members; · A methodology and process for conducting and maintaining Provider profiling; · Ad-Hoc Reports to the Contractor’s multi-disciplinary Quality oversight committee and DCH on results, conclusions, recommendations and implemented system changes; · Annual performance improvement projects (PIPs) that focus on clinical and non-clinical areas; and · Annual Reports on performance improvement projects and a process for evaluation of the impact and assessment of the Contractor’s QAPI program. 4.12.5.3 The Contractor’s QAPI Program Plan must be submitted to DCH for review and approval as updated. 4.12.5.4 The Contractor shall submit any changes to its QAPI Program Plan to DCH for review and prior approval sixty (60) Calendar Days prior to implementation of the change. 4.12.5.5 Upon the request of DCH, the Contractor shall provide any information and documents related to the implementation of the QAPI program.
Appears in 2 contracts
Samples: Contract (Centene Corp), Contract for Provision of Services (Centene Corp)
Quality Assessment Performance Improvement. (QAPI) Program
4.12.5.1 12.2.1 The Contractor shall have in place an ongoing a quality assessment and performance improvement program (QAPI) that specifies the Contractor’s quality measurement and performance improvement activities.
12.2.2 For Medicaid and CHIP Eligible Persons, the QAPI program consistent shall be in compliance with federal requirements specified at 42 CFR 438.240.
4.12.5.2 12.2.3 The Contractor’s QAPI program shall be based on the latest available research in the area of Quality quality assurance and at a minimum must shall include: · :
12.2.3.1 A method of monitoring, analysisanalyzing, evaluation evaluating and improvement of improving the delivery, Quality quality and appropriateness of Health Care health care furnished to all Members Enrollees (including under and over Utilization utilization of services), including those with special Health Care health care needs; · ;
12.2.3.2 Written policies and procedures for Quality quality assessment, Utilization Management utilization management and continuous Quality quality improvement that are periodically assessed for efficacy; · ;
12.2.3.3 A health information system sufficient to support the collection, integration, tracking, analysis and reporting of data; · , in compliance with 42 CFR 438.242;
12.2.3.4 Designated staff with expertise in Quality quality assessment, Utilization Management and continuous Quality quality improvement; · ;
12.2.3.5 Reports that are evaluated, indicated recommendations that are implemented, and feedback provided to Providers and Members; · Enrollees;
12.2.3.6 A methodology and process for conducting and maintaining Provider profiling; · Ad, Credentialing and re-Hoc Reports to the Contractor’s multi-disciplinary Quality oversight committee Credentialing;
12.2.3.7 Procedures for validating completeness and DCH quality of Encounter Data;
12.2.3.8 Annual performance improvement projects (PIPs) as provided in Section 12.3 below;
12.2.3.9 Development of an emergency room (ER) quality initiative program (see Section 12.4 of this Contract);
12.2.3.10 Development of a quality incentive program (see Section 12.5 of this Contract);
12.2.3.11 Reporting on specified performance measures, including specified HEDIS measures (see Section 12.6 of this Contract);
12.2.3.12 Conducting Provider and Enrollee surveys (see Section 12.7 of this Contract);
12.2.3.13 Quarterly reports on program results, conclusions, recommendations and implemented system changes, as specified by ASES; · Annual performance improvement projects (PIPs) that focus on clinical and non-clinical areas; and · Annual Reports on performance improvement projects and a process and
12.2.3.14 Process for evaluation of evaluating the impact and assessment of the Contractor’s QAPI program.
4.12.5.3 12.2.4 The Contractor’s QAPI Program Plan must program shall be submitted to DCH ASES for review and approval as updatedaccording to the timeframe specified in Attachment 12 to this Contract. Any subsequent changes to the QAPI program must be previously approved in writing by ASES, which approval shall not be unreasonably withheld, conditioned, or delayed.
4.12.5.4 12.2.5 The Contractor shall submit any changes to its QAPI Program Plan program to DCH ASES for review and prior approval sixty (60) Calendar Days prior to implementation of the change.
4.12.5.5 12.2.6 Upon the request of DCHASES, the Contractor shall provide any information and documents related to the implementation of the QAPI program.
Appears in 1 contract
Samples: Contract for Health Services Administration (Triple-S Management Corp)
