42 C.F.R. § 438.350

Current through March 31, 2024
Section 438.350 - External quality review

Each State that contracts with MCOs, PIHPs, or PAHPs, or with PCCM entities (described in § 438.310(c)(2) ) must ensure that-

(a) Except as provided in § 438.362 , a qualified EQRO performs an annual EQR for each such contracting MCO, PIHP, PAHP or PCCM entity (described in § 438.310(c)(2) ).
(b) The EQRO has sufficient information to use in performing the review.
(c) The information used to carry out the review must be obtained from the EQR-related activities described in § 438.358 or, if applicable, from a Medicare or private accreditation review as described in § 438.360 .
(d) For each EQR-related activity, the information gathered for use in the EQR must include the elements described in § 438.364(a)(2)(i) through (iv) .
(e) The information provided to the EQRO in accordance with paragraph (b) of this section is obtained through methods consistent with the protocols established by the Secretary in accordance with § 438.352 .
(f) The results of the reviews are made available as specified in § 438.364 .

42 C.F.R. §438.350

81 FR 27853, May 6, 2016, as amended at 82 FR 39, Jan. 3, 2017
81 FR 27852, 5/6/2016; as amended at 82 FR 39, 1/3/2017