Common use of QUALITY ASSURANCE AND COMPLIANCE Clause in Contracts

QUALITY ASSURANCE AND COMPLIANCE. 22.1. The CONTRACTOR shall implement an ongoing comprehensive Quality Assessment and Performance Improvement (QAPI) Program (formerly known as Quality Improvement) for the services it furnishes to beneficiaries. (42 C.F.R. § 438.330 (a)) 22.1.1. The CONTRACTOR’s QAPI covering a description of mechanisms the CONTRACTOR has implemented to assess the accessibility of services within its service delivery area. This shall include goals for responsiveness for timeliness for scheduling of routine appointments, timeliness of services for urgent conditions, and access to after-hours care; and 22.1.2. Evidence of compliance with the requirements for cultural competence and linguistic competence. 22.1.3. The CONTRACTOR’S QAPI Program shall improve CONTRACTOR’s established outcomes through structural and operational processes and activities that are consistent with current standards of practice. 22.1.4. The CONTRACTOR’S QAPI Program will include all the elements of the Placer County Behavioral Health Provider QA Reporting requirements located at: xxxxx://xxx.xxxxxx.xx.xxx/7453/Network-Providers 22.1.5. CONTRACTOR shall adhere to COUNTY requirement of submitting an Annual QAPI and Quarterly updates. 22.1.6. The COUNTY’S Mental Health Provider Plan Requirements that stipulate what to include in the QAPI for providers can be located at: xxxxx://xxx.xxxxxx.xx.xxx/7453/Network-Providers 22.1.7. When submitting QAPI reports, CONTRACTOR shall also submit a Provider Attestation. The Provider Attestation can be located at: xxxxx://xxx.xxxxxx.xx.xxx/7453/Network- Providers 22.2. CONTRACTOR shall maintain a provider directory and update as required. Provider directory must include all required elements as outlined in state and federal regulation 42 C.F.R. § 438.10(e)(2)(vi), all changes shall be submitted within 30 days to Quality Assurance Department. 22.3. CONTRACTOR shall adhere to all network adequacy and timely access standards. 22.4. CONTRACTOR shall have active involvement and participation in the planning, design and execution of the MHP QAPI Program. Participation shall include collection and submission of performance measurement data required by the DHCS, which may include performance measures specified by CMS. 22.4.1. MHP QAPI Program elements include but are not limited to: 22.4.1.1. Timely access to services, including: a) The length of time from initial request to first offered appointment: b) The length of time from initial request to first kept appointment: c) The length of time from initial request to first offered psychiatry appointment: d) The length of time from service request for urgent appointment to actual encounter: e) Psychiatrist and Clinician No-show rates 22.4.1.2. Beneficiary and system outcomes 22.4.1.3. Utilization management 22.4.1.4. Utilization review 22.4.1.5. Provider appeals 22.4.1.6. Credentialing and monitoring 22.4.1.7. Resolution of beneficiary grievances 22.4.1.8. Detection of both underutilization and overutilization of services

QUALITY ASSURANCE AND COMPLIANCE. 22.1. A. The CONTRACTOR shall implement an ongoing comprehensive Quality Assessment and Performance Improvement (QAPI) Program (formerly known as Quality Improvement) for the services it furnishes to beneficiaries. (42 C.F.R. § 438.330 (a).) 22.1.1. 1) The CONTRACTOR’s QAPI covering a description of mechanisms the CONTRACTOR has implemented to assess the accessibility of services within its service delivery area. This shall include goals for responsiveness for timeliness for scheduling of routine appointments, timeliness of services for urgent conditions, and access to after-hours care; and 22.1.2. 2) Evidence of compliance with the requirements for cultural competence and linguistic competencecompetence specified in Attachments 7 and 11. 22.1.3. 3) The CONTRACTOR’S ’s QAPI Program shall improve CONTRACTOR’s established outcomes through structural and operational processes and activities that are consistent with current standards of practice. 22.1.4. 4) The CONTRACTOR’S QAPI Program will include all the elements of the Placer County Behavioral Health Provider QA Reporting requirements located at: xxxxx://xxx.xxxxxx.xx.xxx/7453/Network-Providersxxxxx://xxx.xxxxxx.xx.xxx/2026/Newsletters-Meeting-Minutes-Work-Plans-S 22.1.5. 5) CONTRACTOR shall adhere to COUNTY requirement of submitting an Annual QAPI and Quarterly updates. 22.1.6. 6) The COUNTY’S Mental Health Provider Plan Requirements that stipulate what to include in the QAPI for providers can be located at: xxxxx://xxx.xxxxxx.xx.xxx/7453/Network-Providersxxxxx://xxx.xxxxxx.xx.xxx/2026/Newsletters-Meeting- Minutes-Work-Plans-S 22.1.7. 7) When submitting QAPI reports, CONTRACTOR shall also submit a Provider Attestation. The Provider Attestation can be located at: xxxxx://xxx.xxxxxx.xx.xxx/7453/Network- Providersxxxxx://xxx.xxxxxx.xx.xxx/1981/Provider-Forms 22.2. B. CONTRACTOR shall maintain a provider directory and update as required. Provider directory must include all required elements as outlined in state and federal regulation 42 C.F.R. § 438.10(e)(2)(vi), all changes shall be submitted within 30 days to Quality Assurance Departmentposted on the CONTRACTOR’s website. 22.3. C. CONTRACTOR shall adhere to all network adequacy and timely access standards. 22.4. D. CONTRACTOR shall have active involvement and participation participate in the planning, design and execution of the MHP QAPI Program. Participation shall include collection and submission of performance measurement data required by the DHCS, which may include performance measures specified by CMS. 22.4.1. 1) MHP QAPI Program elements include but are not limited to: 22.4.1.1. : • Timely access to services, including: a1) The length of time from initial request to first offered appointment: b2) The length of time from initial request to first kept appointment: c3) The length of time from initial request to first offered psychiatry appointment: d4) The length of time from service request for urgent appointment to actual encounter: e5) Psychiatrist and Clinician No-show rates 22.4.1.2. rates • Beneficiary and system outcomes 22.4.1.3. ; • Utilization management 22.4.1.4. management; • Utilization review 22.4.1.5. review; • Provider appeals 22.4.1.6. appeals, • Credentialing and monitoring 22.4.1.7. monitoring; • Resolution of beneficiary grievances 22.4.1.8. grievances; • Detection of both underutilization and overutilization of services; • Beneficiary and family satisfaction surveys; • Evaluation of grievances, appears and state fair hearings; • Monitoring the safety and effectiveness of medication practices (this shall be under the supervision of a licensed prescriber; • Identification and resolution of clinical issues affecting beneficiaries’ system wide outcome. • Identification and implementation of mechanisms to monitor appropriate and timely intervention of occurrences that raise quality of care concerns. • 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. E. CONTRACTOR shall take steps to assure that decisions for utilization management, beneficiary education, coverage of services, and any other areas to which shall be consistent with the Specialty Mental Health Services Practice Guidelines (42 C.F.R. § 438.236(d)).

QUALITY ASSURANCE AND COMPLIANCE. 22.121.1. The CONTRACTOR shall implement an ongoing comprehensive Quality Assessment and Performance Improvement (QAPI) Program (formerly known as Quality Improvement) for the services it furnishes to beneficiaries. (42 C.F.R. § 438.330 (a)) 22.1.121.1.1. The CONTRACTOR’s QAPI covering a description of mechanisms the CONTRACTOR has implemented to assess the accessibility of services within its service delivery area. This shall include goals for responsiveness for timeliness for scheduling of routine appointments, timeliness of services for urgent conditions, and access to after-hours care; and 22.1.221.1.2. Evidence of compliance with the requirements for cultural competence and linguistic competence. 22.1.321.1.3. The CONTRACTOR’S QAPI Program shall improve CONTRACTOR’s established outcomes through structural and operational processes and activities that are consistent with current standards of practice. 22.1.421.1.4. The CONTRACTOR’S QAPI Program will include all the elements of the Placer County Behavioral Health Provider QA Reporting requirements located at: xxxxx://xxx.xxxxxx.xx.xxx/7453/Network-Providers 22.1.521.1.5. CONTRACTOR shall adhere to COUNTY requirement of submitting an Annual QAPI and Quarterly updates. 22.1.621.1.6. The COUNTY’S Mental Health Provider Plan Requirements that stipulate what to include in the QAPI for providers can be located at: xxxxx://xxx.xxxxxx.xx.xxx/7453/Network-Providers 22.1.721.1.7. When submitting QAPI reports, CONTRACTOR shall also submit a Provider Attestation. The Provider Attestation can be located at: xxxxx://xxx.xxxxxx.xx.xxx/7453/Network- Providers 22.221.2. CONTRACTOR shall maintain a provider directory and update as required. Provider directory must include all required elements as outlined in state and federal regulation 42 C.F.R. § 438.10(e)(2)(vi), all changes shall be submitted within 30 days to Quality Assurance Department. 22.321.3. CONTRACTOR shall adhere to all network adequacy and timely access standards. 22.421.4. CONTRACTOR shall have active involvement and participation in the planning, design and execution of the MHP QAPI Program. Participation shall include collection and submission of performance measurement data required by the DHCS, which may include performance measures specified by CMS. 22.4.121.4.1. MHP QAPI Program elements include but are not limited to: 22.4.1.121.4.1.1. Timely access to services, including: a) The length of time from initial request to first offered appointment: b) The length of time from initial request to first kept appointment: c) The length of time from initial request to first offered psychiatry appointment: d) The length of time from service request for urgent appointment to actual encounter: e) Psychiatrist and Clinician No-show rates 22.4.1.221.4.1.2. Beneficiary and system outcomes 22.4.1.3outcomes 21.4.1.3. Utilization management 22.4.1.421.4.1.4. Utilization review 22.4.1.521.4.1.5. Provider appeals 22.4.1.621.4.1.6. Credentialing and monitoring 22.4.1.721.4.1.7. Resolution of beneficiary grievances 22.4.1.821.4.1.8. Detection of both underutilization and overutilization of services