Quality Review Activities. OSMI shall assist Provider in establishing a quality oversight program and program evaluation standards to promote the efficacy of DME and related services provided by the Provider.
Quality Review Activities. 7.2.1 The HCA, Office of the State Auditor, or any of their duly-authorized representatives, may conduct announced and unannounced:
7.2.1.1 Surveys, audits, and reviews of compliance with licensing and certification requirements and the terms of this Contract.
7.2.1.2 Audits regarding the quality, appropriateness, and timeliness of behavioral health services provided under this Contract.
7.2.1.3 Audits and inspections of financial records.
7.2.2 The Contractor shall participate with HCA in review activities. Participation will include at a minimum:
7.2.2.1 The submission of requested materials necessary for an HCA initiated review within thirty (30) days of the request.
7.2.2.2 The completion of site visit protocols provided by HCA.
7.2.2.3 Assistance in scheduling interviews and agency visits required for the completion of the review.
7.2.3 The Contractor shall notify HCA when any entity other than the State Auditor performs an audit described above related to any activity contained in this Contract.
Quality Review Activities. 6.3.1 GCBH, the Department of Social and Health Services, Office of the State Auditor, or any of their duly-authorized representatives, may conduct announced and unannounced:
6.3. 1.1 Surveys, audits and reviews of compliance with licensing and certification requirements and the terms ofthis Agreement;
Quality Review Activities. 6.3.1 GCBH, the Department of Social and Health Services, Office of the State Auditor, or any of their duly-authorized representatives, may conduct announced and unannounced:
6.3.1.1 Surveys, audits and reviews of compliance with licensing and certification requirements and the terms of this Agreement;
6.3.1.2 Audits regarding the quality, appropriateness, and timeliness of behavioral health services provided under this Agreement;
6.3.1.3 Audits and inspections of financial records.
6.3.2 The Contractor shall notify GCBH when an entity other than GCBH performs any audit described above related to any activity contained in this Agreement and shall forward the results of any such audit to GCBH.
Quality Review Activities. 5.5.1. The Department of Social and Health Services, Office of the State Auditor, or any of their duly-authorized representatives, may conduct announced and unannounced:
5.5.1.1. Surveys, audits and reviews of compliance with licensing and certification requirements and the terms of this Agreement.
5.5.1.2. Audits regarding the quality, appropriateness, and timeliness of mental health services provided under this Agreement. 5.5.1.3. Audits and inspections of financial records.
Quality Review Activities. 5.4.1. Great Rivers, Healthcare Authority (HCAHCA), Office of the State Auditor, or any of their duly authorized representatives may conduct announced and unannounced:
5.4.1.1. Surveys, audits, and reviews of compliance with licensing and certification requirements and the terms of this Agreement.
5.4.1.2. Reviews regarding the quality, appropriateness, and timeliness of behavioral health services provided under this Agreement
5.4.1.3. Audits and inspections of financial records.
5.4.1.4. On-site inspections of any contractor and subcontractor locations.
5.4.2. The Contractor shall notify Great Rivers when an entity other than Great Rivers performs any audit described above related to any activity contained in this Agreement.
Quality Review Activities. The Contractor shall participate with DSHS in review activities. Participation shall include at a minimum:
8.4.1. The submission of requested materials necessary for a DSHS-initiated review within 30 calendar days of the request.
8.4.2. The completion of site visit protocols provided by DSHS.
8.4.3. Assistance in scheduling interviews and agency visits required for the completion of the review.
Quality Review Activities. The HCA, Office of the State Auditor, or any of their duly-authorized representatives, may conduct announced and unannounced: Surveys, audits and reviews of compliance with licensing and certification requirements and the terms of this Contract; Audits regarding the quality, appropriateness, and timeliness of Behavioral Health services provided under this Contract; and Audits and inspections of financial records. The Contractor shall participate with HCA in review activities. Participation will include at a minimum: The submission of requested materials necessary for an HCA initiated review within thirty (30) days of the request. The completion of site visit protocols provided by HCA. Assistance in scheduling interviews and agency visits required for the completion of the review. The Contractor shall notify HCA when an entity other than the State Auditor performs any audit described above related to any activity contained in this Contract. HCA defined reporting and data submission methods for Performance Measurement and Reporting: The Contractor shall comply with the reporting and data submissions requirements as directed by HCA and shall make reports available to HCA at least annually through the HCA monitoring process or more frequently, as requested by HCA. Should the HCA adopt a subsequent set of requirements during the term of this Contract, the HCA shall update the performance requirements as necessary. All performance measures are subject to an audit; HCA will fund the audit. The Contractor shall report all instances of suspected Enrollee abuse to HCA The Contractor shall adopt Behavioral Health practice guidelines known to be effective in improving health outcomes. Practice guidelines shall meet the following requirements: Valid and reliable clinical scientific evidence; In the absence of scientific evidence, on professional standards; or In the absence of scientific evidence and professional standards, a consensus of Health Care Professionals in the particular field. The Contractor may adopt guidelines developed by recognized sources that develop or promote evidence-based clinical practice guidelines such as United States Preventive Services Task Force (USPSTF), voluntary health organizations, National Institute of Health Centers, or the Substance Abuse and Mental Health Services Administration (SAMHSA). If the Contractor does not adopt guidelines from recognized sources, board-certified practitioners must participate in the development of the gui...
Quality Review Activities. The Contractor must participate with GCBH in review activities. Participation must include, at a minimum: Remedial Action may be initiated in accordance with the Remedial Action section of this Agreement.
Quality Review Activities. 7.2.1 The Contractor shall submit to annual compliance monitoring reviews by HCA. The monitoring review process and examination shall be implemented and conducted by HCA or its agent using standards established by HCA. Results are used to identify and correct problems and to improve care and services to Individuals served by this Contract.
7.2.2 If the Contractor has had an accreditation review or visit by the National Committee for Quality Assurance (NCQA) or another accrediting body, the Contractor shall provide the complete report from that organization to HCA. If permitted by the accrediting body, the Contractor shall allow a state representative to accompany any accreditation review team during the site visit in an official observer status. The state representative shall be allowed to share information with the HCA compliance monitoring review as needed to reduce duplicated work for both the Contractor and the state.
7.2.3 The HCA, Office of the State Auditor, or any of their duly-authorized representatives, may conduct announced and unannounced:
7.2.3.1 Surveys, audits, and reviews of compliance with licensing and certification requirements and the terms of this Contract.
7.2.3.2 Audits regarding the quality, appropriateness, and timeliness of behavioral health services provided under this Contract.
7.2.3.3 Audits and inspections of financial records.
7.2.4 The Contractor shall participate with HCA in Quality Review activities. Participation will include at a minimum:
7.2.4.1 The submission of requested materials necessary for an HCA initiated review within thirty (30) calendar days of the request.
7.2.4.2 The completion of site visit protocols provided by HCA.
7.2.4.3 Assistance in scheduling interviews and agency visits required for the completion of the review.
7.2.5 The Contractor shall notify HCA immediately when any entity other than the State Auditor gives notice of an audit related to any activity contained in this Contract.
