Quality Management Program. Contractor shall maintain a quality management program to review the quality of Covered Services provided by Participating Providers and other subcontractors. Contractor’s quality management program shall be subject to review by Covered California annually to evaluate Contractor’s compliance with requirements set forth in the Quality, Network Management and Delivery System Standards. Contractor shall coordinate and cooperate with Covered California in developing the Quality, Network Management and Delivery System Standards, including (i) participating in meetings and other programs as reasonably requested from time to time by Covered California, (ii) providing mutually agreed upon data and other information required under the Quality, Network Management and Delivery System Standards, and (iii) as otherwise reasonably requested by Covered California. The parties acknowledge and agree that quality related activities contemplated under this Article 4 will be subject to and conducted in compliance with any and all applicable laws, rules and regulations including those relating the confidentiality of medical information and will preserve all privileges set forth at Health and Safety Code § 1370.
Quality Management Program. To adopt and maintain a Quality Management Program consistent with BLUE CROSS standards and approved by BLUE CROSS. This program will cover all Covered Medical Services provided or arranged by PARTICIPATING MEDICAL GROUP for Members. PARTICIPATING MEDICAL GROUP agrees to allow on-site review(s) of its Quality Management Program by BLUE CROSS staff.
Quality Management Program. Contractor shall maintain a quality management program to review the quality of Covered Services provided by Participating Providers and other subcontractors. Contractor’s quality management program shall be subject to review by the Exchange annually to evaluate Contractor’s compliance with requirements set forth in the Quality, Network Management and Delivery System Standards. Contractor shall coordinate and cooperate with the Exchange in developing the Quality, Network Management and Delivery System Standards, including (i) participating in meetings and other programs as reasonably requested from time to time by the Exchange, and (ii) providing mutually agreed upon data and other information required under the Quality, Network Management and Delivery System Standards and (iii) as otherwise reasonably requested by the Exchange. The parties acknowledge and agree that quality related activities contemplated under this Article 4 will be subject to and conducted in compliance with any and all applicable laws, rules and regulations including those relating the confidentiality of medical information and will preserve all privileges set forth at Health and Safety Code § 1370.
Quality Management Program. An ongoing review process and plan which functions to define, monitor, review, and recommend corrective action for managing and improving the quality of health care services to Members.
Quality Management Program. Contractor shall maintain a quality management program to review the quality of Specialized Health Care Services provided by Participating Providers and other subcontractors. Contractor’s quality management program shall be subject to review by the Exchange annually to evaluate Contractor’s compliance with requirements set forth in the Quality, Network Management and Delivery System Standards. Contractor shall coordinate and cooperate with the Exchange in developing the Quality, Network Management and Delivery System Standards, including (i) participating in meetings and other programs as reasonably requested from time to time by the Exchange, and (ii) providing mutually agreed upon data and other information required under the Quality, Network Management and Delivery System Standards and/or (iii) as otherwise reasonably requested by the Exchange. The parties acknowledge and agree that quality related activities contemplated under this Article 4 will be subject to and conducted in compliance with any and all applicable laws, rules and regulations including those relating the confidentiality of medical information and will preserve all privileges set forth at Health and Safety Code 1370. Consistent with The Exchange's mission to promote better care, better health and lower cost as part of a Quality Improvement Strategy, Contractor agrees to:
Quality Management Program. The Contractor shall have an ongoing quality management program for the services it furnishes to members. The quality management program shall include but is not limited to:
Quality Management Program. The Contractor shall ensure its Quality Management (QM) program addresses GFS/FBG requirements according to this Contract and meets Crisis Services Performance Measures, described in this Contract and Exhibit F, Federal Block Grant Annual Progress Report. It shall be the obligation of the Contractor to remain current with all GFS/FBG requirements. The Contractor shall participate in a Community BHAB and attend meetings as required by established bylaws. 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. Audits and inspections of financial records. The Contractor shall participate with HCA in Quality Review activities. Participation will include at a minimum: The submission of requested materials necessary for an HCA initiated review within thirty (30) calendar 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 immediately when any entity other than the State Auditor gives notice of an audit related to any activity contained in this Contract.
Quality Management Program. The Contractor shall ensure its Quality Management (QM) program addresses GFS requirements. 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, related to GFS services. 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. Performance-Based Goals and Other Reporting Requirements At HCA’s discretion, performance will be linked to payment. 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 HCA adopt a subsequent set of requirements during the term of this Contract, HCA shall update the performance requirements as necessary. All performance measures are subject to an audit.
Quality Management Program. See Section 4 “Other Contractual Requirements” for more details, requirements, and performance measures The scope of this Contract includes the requirement for a Quality Management Program established by the Contractor as a minimum framework for the Contractor for self-monitoring, self-evaluation, and self-reporting. The Contractor’s Quality Management Program requires a continuous process of self-monitoring and self-evaluation of performance. The expectation is all performance failures will be identified and addressed by the Contractor without Department involvement. When performance failures are identified, the Contractor is expected to correct the failures and review its Operations Plan and Quality Management Plan to determine changes needed to prevent additional performance failures. The Contractor is expected to document all changes and make all documentation available to the Department for review upon request. The Quality Management Program should include a system of checks and balances for the Contractor to validate their operations and provide a consistent and baseline approach to Quality Management practices to ensure compliance with all Contract performance measures. The Quality Management Program should identify the individuals responsible for quality control measures and specific actions that are used to ensure quality results. Quality Management consists of three primary components: Quality Checks, Quality Control Reviews (Back Checks), and Quality Assurance Reviews (Process Reviews).
Quality Management Program. Contractor shall maintain a quality management program to review the quality of Specialized Health Care Services provided by Participating Providers and other subcontractors. Contractor’s quality management program shall be subject to review by the Exchange annually to evaluate Contractor’s compliance with requirements set forth in the Quality, Network Management and Delivery System Standards. Contractor shall coordinate and cooperate with the Exchange in developing the Quality, Network Management and Delivery System Standards, including (i) participating in meetings and other programs as reasonably requested from time to time by the Exchange, (ii) providing mutually agreed upon data and other information required under the Quality, Network Management and Delivery System Standards, and
