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DELAWARE HEALTHY CHILDREN PROGRAM (DHCP) 27
Transmittal # DHCP SPA #5 Approval Date July 28, 2009 Supersedes Transmittal # DHCP SPA #4 Effective Date April 1, 2009
applicable State statutes, rules, guidelines, and policies and with all metropolitan ordinances and policies;
(o) Assure that control measures for tuberculosis, sexually transmitted diseases, and communicable disease are carried out in accordance with applicable laws and guidelines and contained in each provider manual;
(p) Serve as a liaison between the MCO and its providers and communicate regularly with the MCO's providers, including oversight of provider education, in-service training, and orientation;
(q) Be available to the MCO's medical staff for consultation on referrals, denials, complaints, and problems;
(r) Attend State medical director's meetings;
(s) Maintain current medical information pertaining to clinical practice and guidelines; and
(t) Attend grievance committee meetings when necessary.
External Quality Assurance Reviews
DSS will contract with independent, external evaluators to examine the quality of care provided by MCOs. The State will amend the existing contract with its EQRO for the Title XIX program. The amendment will clearly define the need to keep the populations and associated reporting separate.
The MCO will be required to cooperate with any external quality, independent assessment of its performance, which has been duly authorized by DSS. Independent assessments shall include, but not be limited to, the federally required reviews of (1) access to care, quality of care, cost effectiveness, and the effect of case management; (2) the contractor's quality assurance procedures, implementation of the procedures, and the quality of care provided; and (3) consumer satisfaction surveys.
The MCO agrees to assist in the identification and collection of any data or medical records to be reviewed by the independent assessors and/or DSS. The contractor shall ensure that the data, medical records, and workspace are available to the independent assessors or DSS at the contractor's work site.
DSS will monitor each MCO's adherence to QARI standards through one or more of the following mechanisms:
(a) Review of each MCO's written QAP prior to contract execution;