Quality Management and Improvement Program Clause Samples

Quality Management and Improvement Program. Provider will participate in, cooperate with and comply with all quality management and improvement program requirements and all decisions rendered by United in connection with the quality management and improvement program. Provider also will provide, within ten (10) days of receipt of written or electronic notice, all medical records, review data and other information as may be required or requested under the quality management and improvement program. Records required or requested by United under the quality management and improvement program for VA CCN are not subject to reimbursement by United.

Quality Management and Improvement Program. The MCO’s Medical Director must be responsible for the coordination and implementation of the Quality Management and Improvement Program. The program must have objectives that are measurable, realistic and supported by consensus among the MCO’s medical and quality improvement staff. Through the Quality Management Program, the MCO must have ongoing comprehensive quality assessment and performance improvement activities aimed at improving its internal functioning, improve the delivery of health care services to members and improve health outcomes of its members. The MCO must meet the requirements of 42 CFR 438 subpart D and the National Committee for Quality Assurance (NCQA), including but not limited to the requirements listed below, in developing its quality management program. In doing so, it shall include an assessment of quality and appropriateness of care provided to member with special needs, complete performance improvement projects in a reasonable time so as to allow information about the success of performance improvement projects and to produce new information on quality of care every year. The MCO’s Quality Management and Improvement Program must: • Include developing and maintaining an annual quality improvement plan which sets goals, establishes specific objectives, identifies the strategies and activities to undertake, monitors results and assesses progress toward the goals. • Have written policies and procedures for quality improvement. Policies and procedures must include methods, timelines and individuals responsible for completing each task • Incorporate an internal system for monitoring services, including clinically appropriate data collection and management for clinical studies, internal quality improvement activities, assessment of special needs population and other quality improvement activities requested by OMPP • Participate appropriately in clinical studies, such as the Health Plan Employer Data and Information Set® (HEDIS®) measures and in other studies requested by OMPP, such as assessment of the quality and appropriateness of care provided to members, in accordance with EPSDT/Health Watch requirements • Collect measurement indicator data related to areas of clinical priority and quality of care. The Hoosier Healthwise Clinical Studies and the Quality Improvement Committees will establish areas of clinical priority and indicators of care. These areas may vary from one year to the next, and they will reflect the needs of the Hoosi...

Quality Management and Improvement Program. Provider agrees to comply with the quality management and improvement program of each Payer Plan and to consult with HPN and Payer regarding such activities.

Quality Management and Improvement Program. Provider agrees to comply with the quality management and improvement program of each SelectCare and to consult with SelectCare regarding such activities.

Quality Management and Improvement Program implementation of the Quality Management and Improvement Program. The program shall have objectives that are measurable, realistic and supported by consensus among the

Quality Management and Improvement Program a. The Contractor shall institute processes to assess, plan, implement and evaluate the quality of care provided to behavioral health recipients. The Contractor shall have a quality management and improvement program that fulfills all applicable requirements on Quality Management contained within the ADHS/DBHS Policies and Procedures Manual and the ADHS/DBHS Provider Manual. AHCCCS will monitor all AHCCCS quality management requirements outlined in AHCCCS Medical Policy Manual (AMPM), Chapter 900, for all direct billing services provided by the Contractor under the AHCCCS-Apache Behavioral Health Services Contract. The Quality Management Program shall require monitoring, reporting, and performance improvement activities, as agreed upon in collaboration with ▇▇▇▇ and ▇▇▇▇▇▇. b. The Contractor shall have a sufficient number of qualified personnel to fulfill all quality management functions. The Contractor shall ensure that all activities within quality management are for the purpose of improving quality of care and meeting requirements set forth in this Agreement, as well as agreement with AHCCCS and IHS. The Contractor shall conduct provider monitoring activities and avoid unnecessary review and monitoring that will not assist in improving the quality of care or meeting the requirements of this Agreement. c. The Contractor shall ensure active participation in appropriate data collection and analysis with approval of the White Mountain Apache Tribal Council. The Contractor shall actively participate in the monitoring and tracking of quality improvement findings and shall take such actions as determined necessary to improve the quality of care provided to behavioral health recipients. d. The Contractor shall inform ADHS within one (1) day of its knowledge of significant incidents/accidents involving behavioral health recipients and provide a summary of findings and corrective actions required, if any, following investigation of the incident/accident. e. ADHS intends to enhance its quality management system in order to more effectively monitor the process of improving services under the JK Settlement Agreement. As these changes are implemented, the Contractor shall conform its quality management systems to be consistent with ADHS quality management systems including monitoring and performance improvement activities.

Quality Management and Improvement Program. Provider agrees to comply with the quality improvement and compliance program of PMC and to consult with PMC regarding such activities.

Quality Management and Improvement Program. The quality of Covered Services rendered by Provider to Enrolled Eligible Veteran is subject to the quality management and improvement program described in the VA CCN Requirements. Provider will participate in, cooperate with and comply with all quality management and improvement program requirements and all decisions rendered by OPSS in connection with the quality management and improvement program. Provider also will provide, within ten (10) days of receipt of written notice, all medical records, review data and other information as may be required or requested under the quality management and improvement program.