Common use of Quality Assessment and Monitoring Activities Clause in Contracts

Quality Assessment and Monitoring Activities. SCDHHS is responsible for monitoring the Contractor’s performance to assure the Contractor is in compliance with the Contract provisions and the Policy and Procedure Guide. SCDHHS or its designee, shall coordinate with the Contractor to establish the scope of review, the review site, relevant time frames for obtaining information, and the criteria for review. SCDHHS or its designee, will at least annually monitor the operation of the Contractor for compliance with the provisions of this Contract, the Policy and Procedure Guide, and applicable federal and state laws and regulations. Inspection shall include the Contractor's facilities, as well as auditing and/or review of all records developed under this Contract including periodic medical audits, grievances, enrollments, disenrollments, termination, utilization and financial records, review of the management systems and procedures developed under this Contract and any other areas or materials relevant or pertaining to this Contract. The Contractor shall have the right to review any of the findings and recommendations resulting from contract monitoring and audits. However, once SCDHHS finalizes the results of monitoring and/or audit report, the Contractor must comply with all recommendations resulting from the review. Failure to comply with recommendations for improvement may result in liquidated damages, sanctions and/or enrollment restrictions. 12.7.1 Fee-for-Service Reporting to MCOs

Quality Assessment and Monitoring Activities. SCDHHS is responsible for monitoring the Contractor’s performance to assure the Contractor is in compliance with the Contract provisions and the Policy and Procedure Guide. SCDHHS or its designee, shall coordinate with the Contractor to establish the scope of review, the review site, relevant time frames for obtaining information, and the criteria for review. SCDHHS or its designee, will at least annually monitor the operation of the Contractor for compliance with the provisions of this Contract, the Policy and Procedure Guide, and applicable federal and state laws and regulations. Inspection shall include the Contractor's facilities, as well as auditing and/or review of all records developed under this Contract including periodic medical audits, grievances, enrollments, disenrollments, termination, utilization and financial records, review of the management systems and procedures developed under this Contract and any other areas or materials relevant or pertaining to this Contract. The Contractor shall have the right to review any of the findings and recommendations resulting from contract monitoring and audits. However, once SCDHHS finalizes the results of monitoring and/or audit reportauditing, the Contractor must comply with all recommendations resulting from the review. Failure to comply with recommendations for improvement may result in liquidated damages, sanctions and/or enrollment restrictions. 12.7.1 Fee-for-Service Reporting to MCOs