Alabama Administrative Code
Title 560 - ALABAMA MEDICAID AGENCY
Chapter 560-X-62 - REGIONAL CARE ORGANIZATIONS
Section 560-X-62-.14 - Quality Assurance Process
Universal Citation: AL Admin Code R 560-X-62-.14
Current through Register Vol. 43, No. 02, November 27, 2024
(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.
Author: Sharon Weaver, Administrator, Administrative Procedures Office
Statutory Authority: Code of Ala. 1975, §§ 22-6-150 et seq; 42 CFR Part 438.
Disclaimer: These regulations may not be the most recent version. Alabama may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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