Common use of Quality Monitoring Clause in Contracts

Quality Monitoring. 2.8.1 DCH will have a written strategy for assessing and improving the quality of services provided by the Contractor. In accordance with 42 CFR 438.204, this strategy will, at a minimum, monitor: • The availability of services; • The adequacy of the Contractor’s capacity and services; • The Contractor’s coordination and continuity of care for Members; • The coverage and authorization of services; • The Contractor’s policies and procedures for selection and retention of Providers; • The Contractor’s compliance with Member information requirements in accordance with 42 CFR §438.10; • The Contractor’s compliance with State and federal privacy laws and regulations relative to Member’s confidentiality; • The Contractor’s compliance with Member Enrollment and Disenrollment requirements and limitations; • The Contractor’s Grievance System; • The Contractor’s oversight of all Subcontractor relationships and delegations; • The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Providers’ application of them; • The Contractor’s quality assessment and performance improvement program; and • The Contractor’s health information systems. • The Contractor shall respond to requests for information within the stipulated time frame. 2.8.2 DCH will have a written strategy for assessing and improving the quality of services provided by the Contractor for the Demonstration and the outcomes resulting from those services. This strategy is incorporated in Attachment O.

Quality Monitoring. 2.8.1 DCH will have a written strategy for assessing and improving the quality of services provided by the Contractor. In accordance with 42 CFR 438.204, this strategy will, at a minimum, monitor: • · The availability of services; • · The adequacy of the Contractor’s capacity and services; • · The Contractor’s coordination and continuity of care for Members; • · The coverage and authorization of services; • · The Contractor’s policies and procedures for selection and retention of Providers; • · The Contractor’s compliance with Member information requirements in accordance with 42 CFR §438.10; • · The Contractor’s compliance with State and federal privacy laws and regulations relative to Member’s confidentiality; • · The Contractor’s compliance with Member Enrollment and Disenrollment requirements and limitations; • · The Contractor’s Grievance System; • · The Contractor’s oversight of all Subcontractor relationships and delegations; • · The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Providers’ application of them; • · The Contractor’s quality assessment and performance improvement program; and • · The Contractor’s health information systems. • · The Contractor shall respond to requests for information within the stipulated time frame. 2.8.2 DCH will have a written strategy for assessing and improving the quality of services provided by the Contractor for the Demonstration and the outcomes resulting from those services. This strategy is incorporated in Attachment O.

Quality Monitoring. 2.8.1 DCH will have a written strategy for assessing and improving the quality of services provided by the Contractor. In accordance with 42 CFR 438.204, this strategy will, at a minimum, monitor: • · The availability of services; • · The adequacy of the Contractor’s capacity and services; • · The Contractor’s coordination and continuity of care for Members; • · The coverage and authorization of services; • · The Contractor’s policies and procedures for selection and retention of Providers; • · The Contractor’s compliance with Member information requirements in accordance with 42 CFR §438.10; • · The Contractor’s compliance with State and federal privacy laws and regulations relative to Member’s confidentiality; • · The Contractor’s compliance with Member Enrollment and Disenrollment requirements and limitations; • · The Contractor’s Grievance System; • · The Contractor’s oversight of all Subcontractor relationships and delegations; • · The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Providers’ application of them; • · The Contractor’s quality assessment and performance improvement program; and • · The Contractor’s health information systems. • · The Contractor shall respond to requests for information within the stipulated time frame. 2.8.2 DCH will have a written strategy for assessing and improving the quality of services provided by the Contractor for the Demonstration and the outcomes resulting from those services. This strategy is incorporated in Attachment O.