Common use of QUALITY ASSURANCE AND QUALITY IMPROVEMENT Clause in Contracts

QUALITY ASSURANCE AND QUALITY IMPROVEMENT. The LME/PIHP shall establish a written program for Quality Assessment and Performance Improvement in accordance with 42 C.F.R. §438.240 that shall include Enrollees, family members and providers through a Global Quality Assurance Committee, and the LME/PIHP shall: Provide LIP with a copy of the current program and any subsequent changes within thirty (30) days of changes to the Global Quality Assurance Plan. Measure the performance of LIP’s and Enrollee 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 providers. Measure LIP’s performance through medical record audits and clinical outcomes agreed upon by both parties. Monitor the quality and appropriateness of care furnished to Enrollees and assure compliance with the rules established by the Mental Health Commission, the Secretary of DHHS and G.S. 122C-142. Provide performance feedback to providers including clinical standards and the LME/PIHP expectations. Follow up with LIP concerning grievances reported to LME/PIHP by Enrollees. Provide data about individual Enrollees for research and study to the LIP based on the parameters set by the LME/PIHP.

QUALITY ASSURANCE AND QUALITY IMPROVEMENT. The LME/PIHP shall establish a written program for Quality Assessment and Performance Improvement in accordance with 42 C.F.R. CFR §438.240 that shall include Enrollees, family members and providers through a Global Quality Assurance Committee, and the LME/PIHP shall: : a. Provide LIP CONTRACTOR 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 LIP’s providers and Enrollee 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 providers. . c. Measure LIP’s provider performance through medical record audits and clinical outcomes agreed upon by both parties. . d. Monitor the quality and appropriateness of care furnished to Enrollees and assure compliance with the rules established by the Mental Health Commission, the Secretary of DHHS and G.S. 122C-142. . e. Provide performance feedback to providers including clinical standards and the LME/PIHP expectations. . f. Follow up with LIP CONTRACTOR concerning grievances reported to LME/PIHP by Enrollees. . g. Provide data about individual Enrollees for research and study to the LIP CONTRACTOR based on the parameters set by the LME/PIHP.

QUALITY ASSURANCE AND QUALITY IMPROVEMENT. The LME/PIHP shall establish a written program for Quality Assessment and Performance Improvement in accordance with 42 C.F.R. CFR §438.240 that shall include Enrollees, family members and providers through a Global Quality Assurance Committee, and the LME/PIHP shall: Provide LIP CONTRACTOR with a copy of the current program and any subsequent changes within thirty (30) days of changes to the Global Quality Assurance Plan. Measure the performance of LIP’s providers and Enrollee 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 providers. Measure LIP’s provider performance through medical record audits and clinical outcomes agreed upon by both parties. Monitor the quality and appropriateness of care furnished to Enrollees and assure compliance with the rules established by the Mental Health Commission, the Secretary of DHHS and G.S. 122C-142. Provide performance feedback to providers including clinical standards and the LME/PIHP expectations. Follow up with LIP CONTRACTOR concerning grievances reported to LME/PIHP by Enrollees. Provide data about individual Enrollees for research and study to the LIP CONTRACTOR based on the parameters set by the LME/PIHP.

QUALITY ASSURANCE AND QUALITY IMPROVEMENT. The LME/PIHP shall establish a written program for Quality Assessment and Performance Improvement in accordance with 42 C.F.R. CFR §438.240 that shall include Enrollees, family members and providers through a Global Quality Assurance Committee, and the LME/PIHP shall: : a. Provide LIP Contractor 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 LIP’s Contractor and Enrollee 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 providers. . c. Measure LIP’s Contractor performance through medical record audits and clinical outcomes agreed upon by both parties. . d. Monitor the quality and appropriateness of care furnished to Enrollees and assure compliance with the rules established by the Mental Health Commission, the Secretary of DHHS and G.S. 122C-142. . e. Provide performance feedback to providers including clinical standards and the LME/PIHP expectations. . f. Follow up with LIP Contractor concerning grievances reported to LME/PIHP by Enrollees. . g. Provide data about individual Enrollees for research and study to the LIP Contractor based on the parameters set by the LME/PIHP.