42 C.F.R. § 438.364 External quality review results.
Title 42 - Public Health
(a) Information that must be produced. The State must ensure that the EQR produces at least the following information: (1) A detailed technical report that describes the manner in which the data from all activities conducted in accordance with §438.358 were aggregated and analyzed, and conclusions were drawn as to the quality, timeliness, and access to the care furnished by the MCO or PIHP. The report must also include the following for each activity conducted in accordance with §438.358: (i) Objectives. (ii) Technical methods of data collection and analysis. (iii) Description of data obtained. (iv) Conclusions drawn from the data. (2) An assessment of each MCO's or PIHP's strengths and weaknesses with respect to the quality, timeliness, and access to health care services furnished to Medicaid recipients. (3) Recommendations for improving the quality of health care services furnished by each MCO or PIHP. (4) As the State determines, methodologically appropriate, comparative information about all MCOs and PIHPs. (5) An assessment of the degree to which each MCO or PIHP has addressed effectively the recommendations for quality improvement made by the EQRO during the previous year's EQR. (b) Availability of information. The State must provide copies of the information specified in paragraph (a) of this section, upon request, through print or electronic media, to interested parties such as participating health care providers, enrollees and potential enrollees of the MCO or PIHP, recipient advocacy groups, and members of the general public. The State must make this information available in alternative formats for persons with sensory impairments, when requested. (c) Safeguarding patient identity. The information released under paragraph (b) of this section may not disclose the identity of any patient.
Title 42: Public Health
PART 438—MANAGED CARE
Subpart E—External Quality Review
§ 438.364 External quality review results.
