Common use of QUALITY ASSURANCE AND QUALITY IMPROVEMENT Clause in Contracts

QUALITY ASSURANCE AND QUALITY IMPROVEMENT. Alliance shall establish a written program for Quality Assessment and Performance Improvement in accordance with 42 CFR § 438.240 that shall include Members, family members and providers through a Global Quality Assurance Committee. Provider shall participate in the compliance process and the Alliance Network continuous quality improvement process. Alliance shall also: a. Provide Provider with a copy of the current program and any subsequent changes within thirty (30) days of changes to the Global Quality Assurance Plan. b. Measure the performance of Provider and Member specific outcomes from service provisions based on the global CQI performance indicators. Examples include, but are not limited to, conducting peer review activities such as identification of practices that do not meet standards, recommendation of appropriate action to correct deficiencies, and monitoring of corrective action by Provider. c. Measure Provider performance through medical record audits and clinical outcomes agreed upon by both Parties. d. Monitor the quality and appropriateness of care furnished to Members. e. Provide performance feedback to Providers including clinical standards and Alliance expectations. f. Follow up with Provider concerning grievances reported to Alliance by Members.

QUALITY ASSURANCE AND QUALITY IMPROVEMENT. Alliance shall establish a written program for Quality Assessment and Performance Improvement in accordance with 42 CFR § 438.240 that shall include MembersRecipients, family members and providers through a Global Quality Assurance Committee. Provider shall participate in the compliance process and the Alliance Network continuous quality improvement Continuous Quality Improvement (CQI) process. Alliance shall also: a. Provide Provider with a copy of the current program and any subsequent changes within thirty (30) days of changes to the Global Quality Assurance Plan. b. Measure the performance of Provider and Member Recipient specific outcomes from service provisions based on the global CQI performance indicators. Examples include, but are not limited to, conducting peer review activities such as identification of practices that do not meet standards, recommendation of appropriate action to correct deficiencies, and monitoring of corrective action by Provider. c. Measure Provider performance through medical record audits and clinical outcomes agreed upon by both Parties. d. Monitor the quality and appropriateness of care furnished to MembersRecipients. e. Provide performance feedback to Providers including clinical standards and Alliance expectations. f. Follow up with Provider concerning grievances reported to Alliance by MembersRecipients.