Source: https://www.law.cornell.edu/cfr/text/42/438.358
Timestamp: 2019-08-20 08:36:08
Document Index: 241295470

Matched Legal Cases: ['§ 438', '§ 438', '§ 438', '§ 438', '§ 438', '§ 438', '§ 438', '§ 438', '§ 438', '§ 438', '§ 438']

42 CFR § 438.358 - Activities related to external quality review. | CFR | US Law | LII / Legal Information Institute
Section 438.358. Activities related to external quality review.
42 CFR § 438.358 - Activities related to external quality review.
§ 438.358 Activities related to external quality review.
(1) The State, its agent that is not an MCO, PIHP, PAHP, or PCCM entity (described in § 438.310(c)(2)), or an EQRO may perform the mandatory and optional EQR-related activities in this section.
(b)Mandatory activities.
(1) For each MCO, PIHP, or PAHP the following EQR-related activities must be performed:
(i)Validation of performance improvement projects required in accordance with § 438.330(b)(1) that were underway during the preceding 12 months.
(ii)Validation of MCO, PIHP, or PAHP performance measures required in accordance with § 438.330(b)(2) or MCO, PIHP, or PAHP performance measures calculated by the State during the preceding 12 months.
(iv)Validation of MCO, PIHP, or PAHP network adequacy during the preceding 12 months to comply with requirements set forth in § 438.68 and, if the State enrolls Indians in the MCO, PIHP, or PAHP, § 438.14(b)(1).
(c)Optional activities. For each MCO, PIHP, PAHP, and PCCM entity (described in § 438.310(c)(2)), the following activities may be performed by using information derived during the preceding 12 months:
(1)Validation of encounter data reported by an MCO, PIHP, PAHP, or PCCM entity (described in § 438.310(c)(2)).
(d)Technical assistance. The EQRO may, at the State's direction, provide technical guidance to groups of MCOs, PIHPs, PAHPs, or PCCM entities (described in § 438.310(c)(2)) to assist them in conducting activities related to the mandatory and optional activities described in this section that provide information for the EQR and the resulting EQR technical report.