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back the annual withhold if the external quality improvement 1 organization finds that the managed care organization: 2 (i) Made statistically significant improvement in the seven 3 performance measures as compared to the preceding plan year; or 4 (ii) Scored in the top national medicaid quartile of the 5 performance measures. 6 (f) The amount of withhold annually paid to each managed care 7 organization shall be proportional to findings of statistically 8 significant improvement or top national medicaid quartile scoring by 9 a managed care organization. 10 (g) For no more than two of the four quality focus performance 11 measures, the authority may use an alternate methodology to 12 approximate top national medicaid quartile performance where top 13 quartile performance data is unavailable. 14 (h) For the purposes of this subsection, "external quality 15 improvement organization" means an organization that meets the 16 competence and independence requirements under 42 C.F.R. Sec. 17 438.354, as it existed on the effective date of this section. 18 (((38))) (35)(a) The authority shall ensure that appropriate 19 resources are dedicated to implementing the recommendations of the 20 centers for medicare and medicaid services center for program 21 integrity as provided to the authority in the January 2019 Washington 22 focused program integrity review final report. Additionally, the 23 authority shall: 24 (i) Work to ensure the efficient operations of the managed care 25 plans, including but not limited to, a deconflicting process for 26 audits with and among the managed care plans and the medicaid fraud 27 division at the attorney general's office, to ensure the authority 28 staff perform central audits of cases that appear across multiple 29 managed care plans, versus the audits performed by the individual 30 managed care plans or the fraud division; and 31 (ii) Remain accountable for operating in an effective and 32 efficient manner, including performing program integrity activities 33 that ensure high value in the medical assistance program in general 34 and in medicaid managed care specifically; 35 (A) Work with its contracted actuary and the medicaid forecast 36 work group to develop methods and metrics related to managed care 37 program integrity activity that shall be incorporated into annual 38 rate setting; and 39 p. 968 ESSB 5187.SL