Common use of Quality Improvement (QI) Work Plan Clause in Contracts

Quality Improvement (QI) Work Plan. 1. The Contractor shall have a Quality Improvement (QI) Work Plan covering the current contract cycle with documented annual evaluations and documented revisions as needed. The QI Work Plan shall include: 1) Evidence of the monitoring activities including, but not limited to, review of beneficiary grievances, appeals, expedited appeals, fair hearings, expedited fair hearings, provider appeals, and clinical records review as required by Cal. Code Regs., tit. 9, § 1810.440(a)(5) and 42 C.F.R. § 438.416(a); 2) Evidence that QI activities, including performance improvement projects, have contributed to meaningful improvement in clinical care and beneficiary service; 3) A description of completed and in-process QI activities, including performance improvement projects. The description shall include: a. Monitoring efforts for previously identified issues, including tracking issues over time; b. Objectives, scope, and planned QI activities for each year; and, c. Targeted areas of improvement or change in service delivery or program design. 4) 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 the Contractor’s 24- hour toll-free telephone number, timeliness for scheduling of routine appointments, timeliness of services for urgent conditions, and access to after-hours care; and 5) Evidence of compliance with the requirements for cultural competence and linguistic competence specified in Attachments 7 and 11.

Quality Improvement (QI) Work Plan. 1. A. The Contractor shall have a Quality Improvement (QI) Work Plan covering the current contract cycle with documented annual evaluations and documented revisions as needed. The QI Work Plan shall include: 1) Evidence of the monitoring activities including, but not limited to, review of beneficiary grievances, appeals, expedited appeals, fair hearings, expedited fair hearings, provider appeals, and clinical records review as required by CalXxx. Code Regs., tit. 9, § 1810.440(a)(5) and 42 C.F.R. § 438.416(a); 2) Evidence that QI activities, including performance improvement projects, have contributed to meaningful improvement in clinical care and beneficiary service; 3) A description of completed and in-process QI activities, including performance improvement projects. The description shall include: a. Monitoring efforts for previously identified issues, including tracking issues over time; b. Objectives, scope, and planned QI activities for each year; and, c. Targeted areas of improvement or change in service delivery or program design. 4) 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 the Contractor’s 24- hour toll-free telephone number, timeliness for scheduling of routine appointments, timeliness of services for urgent conditions, and access to after-hours care; and 5) Evidence of compliance with the requirements for cultural competence and linguistic competence specified in Attachments 7 and 11.