Common use of Quality Monitoring Clause in Contracts

Quality Monitoring. 2.8.1 DCH will have a written strategy for assessing and improving the quality of services provided by the Contractor. In accordance with 42 CFR 438.204, this strategy will, at a minimum, monitor: • The availability of services; • The adequacy of the Contractor’s capacity and services; • The Contractor’s coordination and continuity of care for Members; • The coverage and authorization of services; • The Contractor’s policies and procedures for selection and retention of Providers; • The Contractor’s compliance with Member information requirements in accordance with 42 CFR §438.10; • The Contractor’s compliance with State and federal privacy laws and regulations relative to Member’s confidentiality; • The Contractor’s compliance with Member Enrollment and Disenrollment requirements and limitations; • The Contractor’s Grievance System; • The Contractor’s oversight of all Subcontractor relationships and delegations; • The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Providers’ application of them; • The Contractor’s quality assessment and performance improvement program; and • The Contractor’s health information systems. • The Contractor shall respond to requests for information within the stipulated time frame.

Quality Monitoring. 2.8.1 DCH will have a written strategy for assessing and improving the quality of services provided by the Contractor. In accordance with 42 CFR 438.204, this strategy will, at a minimum, monitor: • · The availability of services; • · The adequacy of the Contractor’s capacity and services; • · The Contractor’s coordination and continuity of care for Members; • · The coverage and authorization of services; • · The Contractor’s policies and procedures for selection and retention of Providers; • · The Contractor’s compliance with Member information requirements in accordance with 42 CFR §438.10; • · The Contractor’s compliance with State and federal privacy laws and regulations relative to Member’s confidentiality; • · The Contractor’s compliance with Member Enrollment and Disenrollment requirements and limitations; • · The Contractor’s Grievance System; • · The Contractor’s oversight of all Subcontractor relationships and delegations; • · The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Providers’ application of them; • · The Contractor’s quality assessment and performance improvement program; and • · The Contractor’s health information systems. • · The Contractor shall respond to requests for information within the stipulated time frame.

Quality Monitoring. 2.8.1 DCH will have a written strategy for assessing and improving the quality of services provided by the Contractor. In accordance with 42 CFR 438.204, this strategy will, at a minimum, monitor: • · The availability of services; • · The adequacy of the Contractor’s capacity and services; • · The Contractor’s coordination and continuity of care for Members; • · The coverage and authorization of services; • · The Contractor’s policies and procedures for selection and retention of Providers; • · The Contractor’s compliance with Member information requirements in accordance with 42 CFR §438.10; • · The Contractor’s compliance with State and federal privacy laws and regulations relative to Member’s confidentiality; • · The Contractor’s compliance with Member Enrollment and Disenrollment requirements and limitations; • · The Contractor’s Grievance System; • · The Contractor’s oversight of all Subcontractor relationships and delegations; • · The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Providers’ application of them; • · The Contractor’s quality assessment and performance improvement program; and • · The Contractor’s health information systems. • · The Contractor shall respond to requests for information within the stipulated time frame.