Quality Management and Improvement Program. The Contractor’s Medical Director shall be responsible for the coordination and implementation of the Quality Management and Improvement Program. The program shall have objectives that are measurable, realistic and supported by consensus among the Contractor’s medical and quality improvement staff. Through the Quality Management and Improvement Program, the Contractor shall have ongoing comprehensive quality assessment and performance improvement activities aimed at improving the delivery of health care services to members. As a key component of its Quality Management and Improvement Program, the Contractor shall develop incentive programs for both providers and members, with the ultimate goal of encouraging appropriate utilization of health care resources and improving health outcomes of Hoosier Healthwise members. The Contractor shall establish different provider and member incentives for its Hoosier Healthwise population.
Quality Management and Improvement Program. The Contractor’s Medical Director shall be responsible for the coordination and implementation of the Quality Management and Improvement Program. The program shall have objectives that are measurable, realistic and supported by consensus among the Contractor’s medical and quality improvement staff. Through the Quality Management and Improvement Program, the Contractor shall have ongoing comprehensive quality assessment and performance improvement activities aimed at improving the delivery of health care services to members. As a key component of its Quality Management and Improvement Program, the Contractor shall develop incentive programs for both providers and members, with the ultimate goal of encouraging appropriate utilization of health care resources and improving health outcomes of HIP members. The Contractor may establish different provider and member incentives for its HIP populations. As a part of the Contractor’s Quality Management and Improvement Program, the Contractor shall participate in OMPP’s annual performance improvement program. The Contractor shall meet the requirements of 42 CFR 438 subpart D on Quality Assessment and Performance Improvement and the National Committee for Quality Assurance (NCQA), including but not limited to the requirements listed below, in developing its Quality Management and Improvement Program and the Quality Management and Improvement Program Work Plan. In doing so, it shall include (i) an assessment of quality and appropriateness of care provided to members with special needs, including all medically frail HIP members; (ii) complete performance improvement projects in a reasonable time so as to allow information about the success of performance improvement projects to be incorporated into subsequent quality improvement projects; and (iii) produce quality of care reports at least annually. The Contractor’s Quality Management and Improvement Program shall: Include developing and maintaining an annual Quality Management and Improvement Program Work Plan which sets goals, establishes specific objectives, identifies the strategies and activities to undertake, monitors results and assesses progress toward the goals. Have in effect mechanisms to detect both underutilization and overutilization of services. The activities the Contractor takes to address underutilization and overutilization must be documented. Have written policies and procedures for quality improvement. Policies and procedures must include metho...
Quality Management and Improvement Program. Provider agrees to comply with the quality management and improvement program of each Payer Plan and to consult with HPN and Payer regarding such activities.
Quality Management and Improvement Program. Provider agrees to comply with the quality management and improvement program of each SelectCare and to consult with SelectCare regarding such activities.
Quality Management and Improvement Program. Provider will participate in, cooperate with and comply with all quality management and improvement program requirements and all decisions rendered by United in connection with the quality management and improvement program. Provider also will provide, within ten (10) days of receipt of written notice or electronic, all medical records, review data and other information as may be required or requested under the quality management and improvement program. Records required or requested by United under the quality management and improvement program for VA CCN are not subject to reimbursement by United.
Quality Management and Improvement Program implementation of the Quality Management and Improvement Program. The program shall have objectives that are measurable, realistic and supported by consensus among the
Quality Management and Improvement Program. The quality of Covered Services rendered by Provider to Enrolled Eligible Veteran is subject to the quality management and improvement program described in the VA CCN Requirements. Provider will participate in, cooperate with and comply with all quality management and improvement program requirements and all decisions rendered by OPSS in connection with the quality management and improvement program. Provider also will provide, within ten (10) days of receipt of written notice, all medical records, review data and other information as may be required or requested under the quality management and improvement program.
Quality Management and Improvement Program a. The Contractor shall institute processes to assess, plan, implement and evaluate the quality of care provided to behavioral health recipients. The Contractor shall have a quality management and improvement program that fulfills all applicable requirements on Quality Management contained within the ADHS/DBHS Policies and Procedures Manual and the ADHS/DBHS Provider Manual. AHCCCS will monitor all AHCCCS quality management requirements outlined in AHCCCS Medical Policy Manual (AMPM), Chapter 900, for all direct billing services provided by the Contractor under the AHCCCS-Apache Behavioral Health Services Contract. The Quality Management Program shall require monitoring, reporting, and performance improvement activities, as agreed upon in collaboration with XXXX and XXXXXX.
b. The Contractor shall have a sufficient number of qualified personnel to fulfill all quality management functions. The Contractor shall ensure that all activities within quality management are for the purpose of improving quality of care and meeting requirements set forth in this Agreement, as well as agreement with AHCCCS and IHS. The Contractor shall conduct provider monitoring activities and avoid unnecessary review and monitoring that will not assist in improving the quality of care or meeting the requirements of this Agreement.
c. The Contractor shall ensure active participation in appropriate data collection and analysis with approval of the White Mountain Apache Tribal Council. The Contractor shall actively participate in the monitoring and tracking of quality improvement findings and shall take such actions as determined necessary to improve the quality of care provided to behavioral health recipients.
d. The Contractor shall inform ADHS within one (1) day of its knowledge of significant incidents/accidents involving behavioral health recipients and provide a summary of findings and corrective actions required, if any, following investigation of the incident/accident.
e. ADHS intends to enhance its quality management system in order to more effectively monitor the process of improving services under the JK Settlement Agreement. As these changes are implemented, the Contractor shall conform its quality management systems to be consistent with ADHS quality management systems including monitoring and performance improvement activities.
Quality Management and Improvement Program. Provider agrees to comply with the quality improvement and compliance program of PMC and to consult with PMC regarding such activities.
