Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Standard VIII: Quality Improvement Program
AGENCY FOR HEALTHCARE ADMINISTRATION
MANAGED CARE ORGANIZATIONS
Compliance Monitoring Tool with Specific Contract Standards
CONTRACT SECTION CONTRACT REQUIREMENT COMPLIANT SCORING
CC-VIII.A.2.b.2
CC-VIII.A.2.b.3
21. QI Plan – Provider Role
CC-VIII.A.2.b.4
22. QI Plan-Direct and
Review QI Activities
plan to staff serving on the QI
Program. At a minimum, the training
includes protocols developed by
CMS regarding quality.
The QI Plan describes the role of its
providers in giving input to the QI
Program, whether that is by membership
on the Committee, its Sub-Committees,
or other means.
The health plan’s QI Plan contains the
following components:
a. A standard for how the health plan
assures that QI Program activities
take place throughout the health plan
and documents the results of the QI
Program activities. Protocols for
assigning tasks to the staff and
timelines are included.
b. A standard describing the process to
review and suggest new and/or
improved QI activities.
c. The process for selecting and
directing task forces/committees to
review areas of concern in the
provision of health care services to
enrollees.
d. The process for selecting evaluation
and study design procedures.
e. The process for reporting findings to
appropriate executive authority, staff,
Yes
No
a. Yes
No
b. Yes
No
c. Yes
No
d. Yes
No
e. Yes
No
f. Yes
No
Met
Partially Met
Not Met
Met
Partially Met
Not Met
DOCUMENTS
REVIEWED
State of Florida Compliance Monitoring_Standard_VIII_F2_07_11
Page 5
FINDINGS