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62 establish a program to review the quality of care being provided and identify, evaluate and remedy problems related to access, continuity of care, utilization and monitoring of plan providers. POPULATION 1/CCHIP POPULATION 2/UNBORN OPTION POPULATION 3/MCAP POPULATION 4/MCAIP

7.1.1.

Quality standards

CA RESPONSE:

POPULATION 2/UNBORN OPTION POPULATION 3/ MCAP POPULATION 4/MCAIP

DHCS monitors quality standards through:

• Analysis and trending of reports from health, dental and vision plans. DHCS staff will collect and analyze a variety of reports generated by participating plans, regulatory entities, and external quality review organizations to monitor the quality of care received and to focus plan efforts on areas needing improvement. These reports include:

1. Benefit Grievances: Benefit grievances filed by CHIP Program subscribers with participating plans. Participating plans will be contractually required to report benefit grievances once a year. These reports will be shared with subscribers who request the information. In addition, DHCS will track any publicly available information on the number and type of benefit grievances filed by all subscribers enrolled in a participating plan (Department of Managed Health Care (DMHC) reports all benefit grievances filed with plans annually). Grievance information will be used by DHCS to identify plan performance needing improvement and to form the basis of future performance standards.

2. Regulatory Entity Reports: DHCS will work with the state’s two health insurance industry regulatory entities (the Departments of Insurance and Managed Health Care) to assure that all publicly available data on health plan performance is known to DHCS.

3. Enrollment and Disenrollment Reports: These reports will be generated by the program’s administrative contractor