Common use of Quality Review and Improvement Clause in Contracts

Quality Review and Improvement. 1.8.1 Dentist acknowledges that CMS requires MA Plan to implement quality assessment and improvement programs to monitor the quality assessment and improvement activities of contracting providers. Dentist agrees to (i) participate in MA Plan’s quality assessment and improvement programs, including review by MA Plan’s quality assurance and improvement committees and staff; (ii) to abide by MA Plan’s quality assessment and improvement plans; and (iii) to cooperate with MA Plan to objectively monitor and evaluate the quality of services provided by Dentist at Dentist’s site or otherwise, including, but not limited to, the availability, accessibility, acceptability and continuity of such care. 1.8.2 Dentist shall maintain at all times during the term hereof of a quality assessment and improvement program, which meets all State and federal licensure, accreditation and certification requirements, including, but not limited to, accreditation standards of NCQA or other organizations, as applicable. Upon request, Dentist shall provide MA Plan with Dentist’s quality assessment and improvement plan and a copy of all updates and revisions thereto. 1.8.3 Dentist shall investigate and respond immediately to all quality issues and shall work with CMS and/or MA Plan to resolve accessibility and other quality issues related to Covered Services provided to MA Members. Dentist shall remedy, as soon as reasonably possible, any condition related to patient care that has been determined by CMS, MA Plan or any governmental or accrediting agency to be unsatisfactory. Such remedy may include timely compliance with a corrective action plan, which MA Plan shall monitor. Dentist shall work with CMS and/or MA Plan to continuously assess and improve the quality and accessibility of care provided to MA Members and to resolve problems related to the provision of Covered Services. 1.8.4 Dentist shall ensure that all information provided to CMS and/or MA Plan shall be reliable and complete and shall make such information available to CMS and other State and federal governmental agencies and accrediting organizations upon request. Dentist shall provide information, including, but not limited to, provider and patient specific information. MA Plan shall protect the confidentiality of such information and records (i) which MA Plan must review for accreditation by the NCQA and for credentialing activities that meet NCQA standards, and

Quality Review and Improvement. 1.8.1 Dentist acknowledges that CMS requires MA Plan to implement quality assessment and improvement programs to monitor the quality assessment and improvement activities of contracting providers. Dentist agrees to (i) participate in MA Plan’s quality assessment and improvement programs, including review by MA Plan’s quality assurance and improvement committees and staff; (ii) to abide by MA Plan’s quality assessment and improvement plans; and (iii) to cooperate with MA Plan to objectively monitor and evaluate the quality of services provided by Dentist at Dentist’s site or otherwise, including, but not limited to, the availability, accessibility, acceptability and continuity of such care. 1.8.2 Dentist shall maintain at all times during the term hereof of a quality assessment and improvement program, which meets all State and federal licensure, accreditation and certification requirements, including, but not limited to, accreditation standards of NCQA or other organizations, as applicable. Upon request, Dentist shall provide MA Plan with Dentist’s quality assessment and improvement plan and a copy of all updates and revisions thereto. 1.8.3 Dentist shall investigate and respond immediately to all quality issues and shall work with CMS and/or MA Plan to resolve accessibility and other quality issues related to Covered Services provided to MA Members. Dentist shall remedy, as soon as reasonably possible, any condition related to patient care that has been determined by CMS, MA Plan or any governmental or accrediting agency to be unsatisfactory. Such remedy may include timely compliance with a corrective action plan, which MA Plan shall monitor. Dentist shall work with CMS and/or MA Plan to continuously assess and improve the quality and accessibility of care provided to MA Members and to resolve problems related to the provision of Covered Services. 1.8.4 Dentist shall ensure that all information provided to CMS and/or MA Plan shall be reliable and complete and shall make such information available to CMS and other State and federal governmental agencies and accrediting organizations upon request. Dentist shall provide information, including, but not limited to, provider and patient specific information. MA Plan shall protect the confidentiality of such information and records (i) which MA Plan must review for accreditation by the NCQA and for credentialing activities that meet NCQA standards, andand (ii) which is required by other accrediting organizations. Dentist shall provide information, including, but not limited to, provider and patient specific information, for MA Plan’s quality assessment and improvement activities. MA Plan’s quality assessment and improvement activities include, but are not limited to, (i) accreditation by and credentialing activities of the NCQA and (ii) similar activities of other accrediting organizations. MA Plan shall protect the confidentiality of such information. Dentist shall provide CMS and/or MA Plan access to all patient care protocols, policies and procedures, and any modifications thereto, upon request. 1.8.5 Dentist shall permit, at reasonable times with reasonable notice, inspection of its sites by NCQA and other accrediting organizations. Upon reasonable notice, Dentist shall permit CMS, MA Plan or its designee and government officials to conduct periodic site evaluations of Dentist’s sites. Dentist shall participate in all utilization management, quality assessment and improvement, credentialing, peer review and any other activities required by MA Plan or its designee, and regulatory accrediting agencies. 1.8.6 Dentist shall cooperate with any independent review and improvement organization or other external review organization that CMS and/or MA Plan retains as part of its quality assessment and improvement program.