Common use of Quality Assurance and Performance Improvement (QAPI Clause in Contracts

Quality Assurance and Performance Improvement (QAPI. Program The Contractor shall implement and operate a comprehensive QAPI Program in compliance with the requirements of 42 C.F.R. 438.330 that focuses on health outcomes, health improvement and health-related social needs. The QAPI program shall assess, monitor, evaluate and improve the quality of care provided to Enrollees. QAPI activities of Providers and Subcontractors, if separate from the Contractor’s QAPI activities, shall be integrated into the overall QAPI program. Requirements to participate in QAPI activities, including submission of complete Encounter Record(s), are incorporated into all Provider and Subcontractor contracts and employment agreements. The Contractor’s QAPI program shall provide feedback to the Providers and Subcontractors regarding integration of, operation of, and corrective actions necessary in Provider and Subcontractor QAPI activities. The Contractor shall integrate management activities such as Utilization Management, Risk Management, Enrollee Services, Grievances and Appeals, Population Health Management, Provider Credentialing, Ombudsman Services and Provider Services in its QAPI program. The Contractor’s QAPI program shall use as a guideline the most current NCQA Standards and Guidelines for the Accreditation of MCOs and incorporate best practices and innovations in quality assurance. The Contractor shall collaborate with Enrollees to gain input on development of the QAPI program. The Contractor shall maintain documentation of all Enrollee input, response, conduct of performance improvement activities, and feedback to Enrollees. Documentation shall be made available upon request of the Department or its contracted EQRO. The QAPI program shall at a minimum include:

Quality Assurance and Performance Improvement (QAPI. Program The Contractor shall implement and operate a comprehensive QAPI Program in compliance with the requirements of 42 C.F.R. 438.330 that focuses on health outcomes, health improvement and health-related social needs. The QAPI program shall assess, monitor, evaluate and improve the quality of care provided to Enrollees. QAPI activities of Providers and Subcontractors, if separate from the Contractor’s QAPI activities, shall be integrated into the overall QAPI program. Requirements to participate in QAPI activities, including submission of complete Encounter Record(s), are incorporated into all Provider and Subcontractor contracts and employment agreements. The Contractor’s QAPI program shall provide feedback to the Providers and Subcontractors regarding integration of, operation of, and corrective actions necessary in Provider and Subcontractor QAPI activities. The Contractor shall integrate management activities such as Utilization Management, Risk Management, Enrollee Services, Grievances and Appeals, Population Health Management, Provider Credentialing, Ombudsman Services and Provider Services in its QAPI program. The Contractor’s QAPI program shall use as a guideline the most current NCQA Standards and Guidelines for the Accreditation of MCOs and incorporate best practices and innovations in quality assurance. The Contractor shall collaborate with Enrollees to gain input on development of the QAPI program. The Contractor shall maintain documentation of all Enrollee inputinput , response, conduct of performance improvement activities, and feedback to Enrollees. Documentation shall be made available upon request of the Department or its contracted EQRO. The QAPI program shall at a minimum include: