Quality Oversight and Improvement Sample Clauses

Quality Oversight and Improvement. The quality oversight structure consists of representatives from DLTCRP, OSO, APS, DMMA and the MCOs. DMMA leads the Quality Improvement Committee but partners with the listed agencies and organizations to track, trend and implement processes to address route causes. This committee shall utilize a combination of guidelines, policies and procedures that are unique to the specific agency (ex.: Professional Regulations, Division of Public Health, the Attorney General's office) as well as guidance informed by Title 16 of the Delaware Code, § 903, relevant sections of the QMS, and the contract with the MCOs. As a distinct component of the 1115 demonstration Waiver’s Quality Improvement Strategy (QMS), the state, on an ongoing basis, identify, address and seek to prevent occurrence of abuse, neglect and exploitation. For each performance measure/indicator the state uses to assess compliance, the state utilizes data provided by the MCOs to analyze and assess progress toward the performance measure. Each source of data is analyzed statistically/deductively or inductively. Themes are identified or conclusions drawn and recommendations are formulated where appropriate. Issues that cannot be resolved at the case manager are brought to the attention of the case manager supervisor for further intervention. Problems with service delivery can be brought to the attention of MCO's Quality Improvement Committee (QIC) and DMMA's Quality Initiative Improvement (QII) Task Force for resolution and remediation. As needed, the MCO terminates the contract of a provider whose service provision is inadequate and notifies DMMA of the action. APS staff members participate in the overall quality management strategy by providing feedback to the MCO and DMMA. Staff representatives from DLTCRP and OSO are available to meet with the QIC quarterly and on an as-needed basis. Lastly, the MCO case managers can refer member concerns about provider agencies to the Division of Public Health (for licensing issues), or to the DMMA SUR Unit (for fraud and billing irregularities). An individual applying for nursing facility care or home and community-based services through the Diamond State Health Plan Plus program must meet medical eligibility criteria.