Section 22-6-154 Quality Assurance Committee; Collection and Publication of Information.
AI-assisted research summary: The Medicaid Agency must create a quality assurance committee, and the committee must set and update quality measures. The Agency must evaluate, use, and publish the collected information, with publication limited to aggregate data that does not disclose protected information.
(a) The Medicaid Agency shall create a quality assurance committee appointed by the Medicaid Commissioner. The members of the committee shall serve two-year terms. At least 60 percent of the members shall be physicians who provide care to Medicaid beneficiaries served by a regional care organization. In making appointments to the committee, the Medicaid Commissioner shall seek input from the appropriate professional associations. (b) The committee shall identify objective outcome and quality measures, including measures of outcome and quality for ambulatory care, inpatient care, chemical dependency and mental health treatment, oral health care, and all other health services provided by coordinated care organizations. Quality measures adopted by the committee shall be consistent with existing state and national quality measures. The Medicaid Commissioner shall incorporate these measures into regional care organization contracts to hold the organizations accountable for performance and customer satisfaction requirements. (c) The committee shall adopt outcome and quality measures annually and adjust the measures to reflect the following: (1) The amount of the global budget for a regional care organization. (2) Changes in membership of the organization. (3) The organization’s costs for implementing outcome and quality measures. (4) The community health assessment and the costs of the community health assessment conducted by the organization. (d) The Medicaid Agency shall continuously evaluate the outcome and quality measures adopted by the committee pursuant to this section. (e) The Medicaid Agency shall utilize available data systems for reporting outcome and quality measures adopted by the committee and take actions to eliminate any redundant reporting or reporting of limited value. (f) The Medicaid Agency shall publish the information collected under this section at aggregate levels that do not disclose information otherwise protected by law. The information published shall report, by regional care organizations, all of the following: (1) Quality measures. (2) Costs. (3) Outcomes. (4) Other information, as specified by the contract between the regional care organization and the Medicaid Agency, that is necessary for the Medicaid Agency to evaluate the value of health services delivered by a regional care organization.