Basic Elements of Quality Assessment and Performance Improvement Programs. (A) At minimum, the Contractor shall comply with the following requirements: (1) Conduct PIPs that are designed to achieve, through ongoing measurements and intervention, significant improvement, sustained over time, in clinical and non-clinical areas that are expected to have a favorable effect on health outcomes and Enrollee satisfaction; (2) Submit performance measurement data; (3) Have in effect mechanisms to detect both underutilization and overutilization of services; (4) Have in effect mechanisms to assess the quality and appropriateness of care furnished to Enrollees with Special Health Care Needs; and (5) Have in effect a process for evaluating the impact and effectiveness of the quality assessment and performance improvement program.
Appears in 3 contracts
Sources: Chip Select Health Amendment 1, Chip Premier Access Dental Contract Amendment 2, Chip Premier Access Dental Contract