Quality Strategic Plan Requirements. 4.12.2.1 The Contractor shall support and comply with Georgia Families Quality Strategic Plan. The Quality Strategic Plan is designed to improve the Quality of Care and Service rendered to GF members (as defined in Title 42 of the Code of Federal Regulations (42 CFR) 431.300 et seq. (Safeguarding Information on Applicants and Recipients); 42 CFR 438.200 et seq. (Quality Assessment and Performance Improvement Including Health Information Systems), and 45 CFR Part 164 (HIPAA Privacy Requirements).
4.12.2.2 The GF Quality Strategic Plan promotes improvement in the quality of care provided to enrolled members through established processes. DCH Managed Care & Quality staff’ oversight of the Contractor includes: · Monitoring and evaluating the Contractor’s service delivery system and provider network, as well as its own processes for quality management and performance improvement; · Implementing action plans and activities to correct deficiencies and/or increase the quality of care provided to enrolled members, · Initiating performance improvement projects to address trends identified through monitoring activities, reviews of complaints and allegations of abuse, provider credentialing and profiling, utilization management reviews, etc.; · Monitoring compliance with Federal, State and Georgia Families requirements; · Ensuring the Contractor’s coordination with State registries; · Ensuring Contractor executive and management staff participation in the quality management and performance improvement processes; · Ensure that the development and implementation of quality management and performance improvement activities include contracted provider participation and information provided by members, their families and guardians, and · Identifying the Contractor’s best practices for performance and quality improvement.
Quality Strategic Plan Requirements. 4.12.2.1 The Contractor shall support and comply with Georgia Families Quality Strategic Plan. The Quality Strategic Plan is designed to improve the Quality of Care and Service rendered to GF members (as defined in Title 42 of the Code of Federal Regulations (42 CFR) 431.300 et seq. (Safeguarding Information on Applicants and Recipients); 42 CFR 438.200 et seq. (Quality Assessment and Performance Improvement Including Health Information Systems), and 45 CFR Part 164 (HIPAA Privacy Requirements).
4.12.2.2 The GF Quality Strategic Plan promotes improvement in the quality of care provided to enrolled members through established processes. DCH Managed Care & Quality staff’ oversight of the Contractor includes:
4.12.2.2.1 Monitoring and evaluating the Contractor’s service delivery system and provider network, as well as its own processes for quality management and performance improvement;
4.12.2.2.2 Implementing action plans and activities to correct deficiencies and/or increase the quality of care provided to enrolled members,
4.12.2.2.3 Initiating performance improvement projects to address trends identified through monitoring activities, reviews of complaints and allegations of abuse, provider credentialing and profiling, utilization management reviews, etc.;
4.12.2.2.4 Monitoring compliance with Federal, State and Georgia Families requirements;
4.12.2.2.5 Ensuring the Contractor’s coordination with State registries;
4.12.2.2.6 Ensuring Contractor executive and management staff participation in the quality management and performance improvement processes;
4.12.2.2.7 Ensure that the development and implementation of quality management and performance improvement activities include contracted provider participation and information provided by members, their families and guardians, and
4.12.2.2.8 Identifying the Contractor’s best practices for performance and quality improvement.
