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(e) Incorporate all the "Minimum Quality Assurance and Utilization Management Requirements."

MCOs will be held accountable for monitoring, evaluating, and taking action as necessary to improve the health of its members under contract with DSS. MCOs will also be held accountable for the quality of care delivered by sub- contractors, which must comply with all quality management procedures and requirements of this RFP.

Quality Assurance Policy and Procedures

NOTE: These policies and procedures are already in place for Title XIX. MCOs must distinguish between Title XIX and Title XXI for reporting.

Internal policies and procedures must:

(a) Assure that the utilization management and quality assurance committee has established parameters for operating and meets on a regular schedule which is at least quarterly; committee members must be clearly identified and representative of the MCO's providers, accountable to the medical director and governing body, and must maintain appropriate documentation of the committee's activities, findings, recommendations, and actions;

(b) Provide for regular utilization management and quality assurance reporting to the MCO management and MCO providers, including profiling of provider utilization patterns;

(c) Be developed and implemented by professionals with adequate and appropriate experience in quality assurance;

(d) Provide for systematic data collection and analysis of performance and patient results;

(e) Provide for interpretation of this data to practitioners;