Common use of Internal Quality Management Program Clause in Contracts

Internal Quality Management Program. A. The Contractor shall establish and maintain an internal quality management program following the basic principles of Total Quality Management (TQM) and Continuous Quality Improvement (CQI) that are presently used throughout most industries. This program will be applied to all aspects of the Contractor's performance under this contract. The Contractor shall share TQM and CQI results with HSD. B. The Contractor shall have a quality improvement/quality management program description, work plan and program evaluation that is updated each contract year and provided to HSD for review and approval in a manner to be specified. C. The Contractor’s internal quality management program will include procedures for conducting quarterly internal audits by each HCBS waiver type on a representative random sample of level of care reviews, level of care determinations, service plans and budgets to validate consistent and accurate application of criteria, and that utilization review functions are performed according to established timeframes. Results will be reported to HSD/MAD. D. The Contractor shall conduct regular monitoring of inter-rater reliability of individuals performing UM activities and shall ensure that a remediation process is established and utilized for individuals not meeting at least 90 percent of agreement on sample cases. E. The Contractor’s quality management program shall include data entry accuracy.

Internal Quality Management Program. A. The Contractor shall establish and maintain an internal quality management program following the basic principles of Total Quality Management (TQM) and Continuous Quality Improvement (CQI) that are presently used throughout most industries. This program will be applied to all aspects of the Contractor's performance under this contract. The Contractor shall share TQM and CQI results with HSDHCA. B. The Contractor shall have a quality improvement/quality management program description, work plan plan, and program evaluation that is updated each contract year and provided to HSD HCA for review and approval in a manner to be specified. C. The Contractor’s internal quality management program will include procedures for conducting quarterly internal audits by each HCBS waiver type on a representative random sample of level of care reviews, level of care determinations, service plans plans, and budgets to validate consistent and accurate application of criteria, and that utilization review functions are performed according to established timeframes. Results will be reported to HSDHCA/MAD. D. The Contractor shall conduct regular monitoring of inter-rater reliability of individuals performing UM activities and shall ensure that a remediation process is established and utilized for individuals not meeting at least 90 percent of agreement on sample cases. E. The Contractor’s quality management program shall include data entry accuracy.