EQRO Monitoring Plan Sample Clauses

The EQRO Monitoring Plan clause outlines the requirements and procedures for an External Quality Review Organization (EQRO) to systematically monitor and assess the quality of services provided under a contract. Typically, this clause specifies the scope of monitoring activities, reporting timelines, and the types of data or performance metrics to be reviewed, such as patient outcomes or compliance with regulatory standards. Its core practical function is to ensure ongoing oversight and accountability, helping to identify areas for improvement and maintain high standards of service delivery.
EQRO Monitoring Plan. Beginning in Intergovernmental Agreement year two, DHCS shall monitor the counties at least once per year through the External Quality Review Organizations (EQRO) pursuant to 42 CFR 438.350: 1) Except as provided in §438.362, a qualified EQRO performs an annual EQR for each contracting MCO or PIHP; 2) The EQRO has sufficient information to use in performing the review; a) The contractor shall make the following data elements available, including but not limited to; i. Number of days to first DMC-ODS service at appropriate level of care after referral; ii. Existence of a 24/7 telephone access line with prevalent non-English language(s); iii. Access to DMC-ODS services with translation services in the prevalent non-English language(s); and iv. Number, percentage of denied and time period of authorization requests approved or denied. 3) The information used to carry out the review must be obtained from the EQR-related activities described in §438.358. a) A detailed technical report that describes the manner in which the data from all activities conducted in accordance with § 438.358 were aggregated and analyzed, and conclusions were drawn as to the quality, timeliness, and access to the care furnished by the MCO or PIHP. The report must also include the following for each activity conducted in accordance with § 438.358: i. Objectives. ii. Technical methods of data collection and analysis. iii. Description of data obtained. iv. Conclusions drawn from the data. b) An assessment of each PIHP's strengths and weaknesses with respect to the quality, timeliness, and access to health care services furnished to Medicaid beneficiaries. c) Recommendations for improving the quality of health care services furnished by each PIHP. d) As the State determines, methodologically appropriate, comparative information about all PIHPs. e) An assessment of the degree to which each PIHP has addressed effectively the recommendations for quality improvement made by the EQRO during the previous year's EQR. 4) The information provided to the EQRO in accordance with paragraph (c) of this section is obtained through methods consistent with the protocols established under §438.352; and 5) The results of the reviews are made available as specified in §438.364(a)(1)(i) through (a)(1)(iv).
View SourceView Similar (10)

Related to EQRO Monitoring Plan

  • Staffing Plan The Board and the Association agree that optimum class size is an important aspect of the effective educational program. The Polk County School Staffing Plan shall be constructed each year according to the procedures set forth in Board Policy and, upon adoption, shall become Board Policy.

  • Project Management Plan Developer is responsible for all quality assurance and quality control activities necessary to manage the Work, including the Utility Adjustment Work. Developer shall undertake all aspects of quality assurance and quality control for the Project and Work in accordance with the approved Project Management Plan and

  • Program Monitoring and Evaluation The Recipient shall prepare, or cause to be prepared, and furnish to the Association not later than six months after the Closing Date, a report of such scope and in such detail as the Association shall reasonably request, on the execution of the Program, the performance by the Recipient and the Association of their respective obligations under the Legal Agreements and the accomplishment of the purposes of the Financing.”

  • Project Monitoring Reporting and Evaluation The Recipient shall furnish to the Association each Project Report not later than forty-five (45) days after the end of each calendar semester, covering the calendar semester.

  • Evaluation, Testing, and Monitoring 1. The System Agency may review, test, evaluate and monitor Grantee’s Products and services, as well as associated documentation and technical support for compliance with the Accessibility Standards. Review, testing, evaluation and monitoring may be conducted before and after the award of a contract. Testing and monitoring may include user acceptance testing. Neither the review, testing (including acceptance testing), evaluation or monitoring of any Product or service, nor the absence of review, testing, evaluation or monitoring, will result in a waiver of the State’s right to contest the Grantee’s assertion of compliance with the Accessibility Standards. 2. Grantee agrees to cooperate fully and provide the System Agency and its representatives timely access to Products, records, and other items and information needed to conduct such review, evaluation, testing, and monitoring.