Common use of Quality Management and Utilization Management Clause in Contracts

Quality Management and Utilization Management. The Contractor shall monitor, evaluate and take effective action to identify and address any needed improvements in the quality of care delivered to members in the Hoosier Healthwise program by all providers in all types of settings, in accordance with the provisions set forth in this Scope of Work. In compliance with state and federal regulations, the Contractor shall submit quality improvement data, including data that meets HEDIS standards for reporting and measuring outcomes, to OMPP that includes the status and results of performance improvement projects. Additionally, the Contractor must submit information requested by OMPP to complete the State’s annual Quality Strategy Plan for CMS. For purposes of this Section 6, the following definitions apply. A “performance improvement project” shall mean a plan to remediate an identified program deficiency in response to a sanction or action by OMPP. A “quality improvement project” is a planned strategy for program improvement and is incorporated into the Contractor’s Quality Management and Improvement Program Work Plan.

Quality Management and Utilization Management. ‌ The Contractor shall monitor, evaluate and take effective action to identify and address any needed improvements in the quality of care delivered to members in the Hoosier Healthwise program by all providers in all types of settings, in accordance with the provisions set forth in this Scope of Work. In compliance with state and federal regulations, the Contractor shall submit quality improvement data, including data that meets HEDIS standards for reporting and measuring outcomes, to OMPP that includes the status and results of performance improvement projects. Additionally, the Contractor must submit information requested by OMPP to complete the State’s annual Quality Strategy Plan for CMS. For purposes of this Section 6, the following definitions apply. A “performance improvement project” shall mean a plan to remediate an identified program deficiency in response to a sanction or action by OMPP. A “quality improvement project” is a planned strategy for program improvement and is incorporated into the Contractor’s Quality Management and Improvement Program Work Plan.

Quality Management and Utilization Management. The Contractor shall monitor, evaluate and take effective action to identify and address any needed improvements in the quality of care delivered to members in the Hoosier Healthwise HIP program by all providers in all types of settings, in accordance with the provisions set forth in this Scope of Work. In compliance with state and federal regulations, the Contractor shall submit quality improvement data, including data that meets HEDIS standards for reporting and measuring outcomes, to OMPP that includes the status and results of performance improvement projects. Additionally, the Contractor must shall submit information requested by OMPP to complete the State’s annual Quality Strategy Plan for CMS. For purposes of this Section 69, the following definitions apply. A “performance improvement project” shall mean a plan to remediate an identified program deficiency in response to a sanction or action by OMPP. A “quality improvement project” is a planned strategy for program improvement and is incorporated into the Contractor’s Quality Management and Improvement Program Work Plan.