[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: 42CFR438.230]



[Page 231]

 

                         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.  438.230  Subcontractual relationships and delegation.



    (a) General rule. The State must ensure, through its contracts, that 

each MCO, PIHP, and PAHP--

    (1) Oversees and is accountable for any functions and 

responsibilities that it delegates to any subcontractor; and

    (2) Meets the conditions of paragraph (b) of this section.

    (b) Specific conditions. (1) Before any delegation, each MCO, PIHP, 

and PAHP evaluates the prospective subcontractor's ability to perform 

the activities to be delegated.

    (2) There is a written agreement that--

    (i) Specifies the activities and report responsibilities delegated 

to the subcontractor; and

    (ii) Provides for revoking delegation or imposing other sanctions if 

the subcontractor's performance is inadequate.

    (3) The MCO, PIHP, or PAHP monitors the subcontractor's performance 

on an ongoing basis and subjects it to formal review according to a 

periodic schedule established by the State, consistent with industry 

standards or State MCO laws and regulations.

    (4) If any MCO, PIHP, or PAHP identifies deficiencies or areas for 

improvement, the MCO, PIHP, or PAHP and the subcontractor take 

corrective action.



                  Measurement and Improvement Standards