[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR438.202]



[Page 225-226]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 438_MANAGED CARE--Table of Contents

 

        Subpart D_Quality Assessment and Performance Improvement

 

Sec.  438.202  State responsibilities.



    Each State contracting with an MCO or PIHP must do the following:

    (a) Have a written strategy for assessing and improving the quality 

of managed care services offered by all MCOs and PIHPs.

    (b) Obtain the input of recipients and other stakeholders in the 

development of the strategy and make the strategy available for public 

comment before adopting it in final.

    (c) Ensure that MCOs, PIHPs, and PAHPs comply with standards 

established by the State, consistent with this subpart.

    (d) Conduct periodic reviews to evaluate the effectiveness of the 

strategy, and update the strategy periodically, as needed.

    (e) Submit to CMS the following:

    (1) A copy of the initial strategy, and a copy of the revised 

strategy whenever significant changes are made.



[[Page 226]]



    (2) Regular reports on the implementation and effectiveness of the 

strategy.