Ala. Admin. Code r. 560-X-62-.14

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-62-.14 - Quality Assurance Process

(1) The Medicaid Agency shall have a regional care organization performance monitoring and improvement process that includes at a minimum:

(a) The review of monthly, quarterly and annually-reported quality and performance data, including outcomes and quality measures adopted by the Medicaid Quality Assurance Committee, regional care organization operational and administrative measures, CMS-required performance standards and other measures as deemed necessary by the Medicaid Agency in its contract with a regional care organization and/or in rules promulgated by the Medicaid Agency to manage the regional care organization program.

(b) At least quarterly, a meeting with the executive director, medical director and others as determined by the Medicaid Agency from each regional care organization to share performance results, discuss performance successes and challenges and determine the effectiveness of quality improvement activities

(c) At least annually, a meeting with the Medicaid Quality Assurance Committee to adopt the recommended regional care organization outcome and quality measure set for the upcoming calendar year. Prior to the annual meeting, the Medicaid Agency shall distribute performance reports and other materials, as necessary, to assist Committee members with evaluating the effectiveness of outcome and quality measures and determining whether to change the regional care organization outcome and quality measure set. The Medicaid Agency shall also conduct telephonic, webinar or in-person meetings with the Medicaid Quality Assurance Committee, as necessary, to discuss performance results.

(d) At least annually, a meeting with each regional care organization's provider standards committee to share that regional care organization's performance results for the purpose of determining the effectiveness of provider performance standards and quality measures. This meeting may be conducted by telephonic, webinar or in-person means.

Ala. Admin. Code r. 560-X-62-.14

Amended by Alabama Administrative Monthly Volume XXXII, Issue No. 11, August 29, 2014, eff. 9/15/2014.

Author: Sharon Weaver, Administrator, Administrative Procedures Office

Statutory Authority: Code of Ala. 1975, §§ 22-6-150 et seq; 42 CFR Part 438.