Common use of State Quality Monitoring Reports Clause in Contracts

State Quality Monitoring Reports. Pursuant to Section 2.8, the Contractor shall report, upon request by DCH, information to support the State’s Quality Monitoring Functions in accordance with 42 CFR 438.204. These Reports shall include information on: · 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 42CFR 438.10; · The Contractor’s compliance with Title 45 of the Code of Federal 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 sub contractual relationships and delegations therein; · The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Provider’s application of them; · The Contractor’s quality assessment and performance improvement program; and · The Contractor’s health information systems.

State Quality Monitoring Reports. Pursuant to Section section 2.8, the Contractor shall report, upon request by DCH, information to support the State’s Quality Monitoring Functions in accordance with 42 CFR 438.204. These Reports shall include information on: · 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 42CFR 438.10; · The Contractor’s compliance with Title 45 of the Code of Federal Regulations CFR 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 sub contractual relationships and delegations therein; · The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Provider’s application of them; · The Contractor’s quality assessment and performance improvement program; and · The Contractor’s health information systems.

State Quality Monitoring Reports. Pursuant to Section 2.8, the Contractor shall report, upon request by DCH, information to support the State’s Quality Monitoring Functions in accordance with 42 CFR 438.204. These Reports shall include information on: · • 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 42CFR 438.10; · • The Contractor’s compliance with Title 45 of the Code of Federal 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 sub contractual relationships and delegations therein; · • The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Provider’s application of them; · • The Contractor’s quality assessment and performance improvement program; and · • The Contractor’s health information systems.

State Quality Monitoring Reports. Pursuant to Section 2.8, the Contractor shall report, upon request by DCH, information to support the State’s Quality Monitoring Functions in accordance with 42 CFR 438.204. These Reports shall include information on: · • 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 42CFR 438.10; · 125 • The Contractor’s compliance with Title 45 of the Code of Federal 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 sub contractual relationships and delegations therein; · • The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Provider’s application of them; · • The Contractor’s quality assessment and performance improvement program; and · • The Contractor’s health information systems.

State Quality Monitoring Reports. Pursuant to Section section 2.8, the Contractor shall report, upon request by DCH, information to support the State’s Quality Monitoring Functions in accordance with 42 CFR 438.204. These Reports shall include information on: · The availability of services; 183 · 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 42CFR 438.10; · The Contractor’s compliance with Title 45 of the Code of Federal Regulations CFR 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 sub contractual relationships and delegations therein; · The Contractor’s adoption of practice guidelines, including the dissemination of the guidelines to Providers and Provider’s application of them; · The Contractor’s quality assessment and performance improvement program; and · The Contractor’s health information systems.