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National Committee on Quality Assurance, the Joint Commission on the Accreditation of Healthcare Organizations, or the State of California’s Medi-Cal Managed Care Program. The contractor must also maintain a system of accountability for quality improvement activities which includes the participation of the contractor’s governing body, the designation of a Quality Improvement Committee, supervision of the activities of the Medical Director, and the inclusion of contracted physicians and other providers in the process of quality improvement development and performance. Risk Assessment and Adjustment Process: MRMIB will implement a risk assessment and adjustment (RARA) process for Healthy Families similar to that which MRMIB uses in the HIPC. MRMIB believes that risk adjustment is critical to providing quality care. RARA provides the necessary balance to the aggressive price negotiations undertaken in a purchasing pool. Through use of risk adjusted premiums, plans that provide quality services in an efficient manner accrue financial benefits. MRMIB intends to implement RARA in the third year of program operations. Ongoing Efforts to Improve Quality Measures and Accountability: MRMIB will establish a Children’s and Adolescent’s Clinical Improvement Work Group. The purpose of the group is to expand the numbers of reportable clinical quality measures and develop an approach to increasing health plan’s accountability for clinical quality improvements. The starting point for the work group’s activities will be the December 4, 1997 report “A Clinical Quality Accountability Framework: California’s Healthy Families Program” (See Attachment B), particularly the section on standardized patient satisfaction monitoring and reporting. The workgroup will meet at least quarterly and will develop recommendations for improvements to the program’s quality improvement strategy by December of 1999. These recommendations would be incorporated in contracts for the contracting period July 1, 2000 through June 30, 2002. The work group may also make interim recommendations for the contract year July 1, 1999 through June 30, 2000. Health plan contractors must participate in the workgroup. AIM Quality Assurance Measures The AIM program relies on the quality assurance requirements of the Knox-Keene Act which regulates health plans. These requirements are detailed on pg. 20 of the state plan and include requirements governing accessibility of health services, consumer protection and quality assurance. Quality assurance requirements specifically require that plans have quality assurance programs, and that providers establish a program to Effective Date: Approval Date: November 1, 2009 HFP Family Contribution Increase November 1, 2009 HFP Co-Payment Increase November 1, 2009 HFP Limited Dental Plan Choice for New Subscribers

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