N.M. Admin. Code § 8.308.21.9
Current through Register Vol. 35, No. 20, October 22, 2024
Section 8.308.21.9 - QUALITY MANAGEMENT A HSD managed care organization (MCO) quality management program includes a philosophy, a method of management, and a structured system designed to improve the quality of services; includes both quality assurance and quality improvement activities; and is incorporated into the health care delivery and administrative systems.
A. Quality management (QM) program structure: The MCO shall have QM structure and processes as detailed in the medicaid managed care services agreement or the medical assistance division (MAD) managed care policy manual.B. QM program description: The MCO shall develop a written QM and a quality improvement (QI) program description that includes the requirements described in the medicaid managed care services agreement or the managed care policy manual.C. QM and QI program principles: The MCO QM and QI programs are based on principles of continuous quality improvement (CQI) and total quality management (TQM). Such an approach will: (1) recognize clinical and non-clinical opportunities are unlimited;(3) use real-time input from members and MCO contracted providers to develop CQI activities; and(4) require on-going measurement of effectiveness and improvement.D. QM program evaluation: The MCO will have a written QM and QI program evaluation as described in the medicaid managed care services agreement or the managed care policy manual.N.M. Admin. Code § 8.308.21.9
8.308.21.9 NMAC - N, 1-1-14, Adopted by New Mexico Register, Volume XXIX, Issue 08, April 24, 2018, eff. 5/1/2018