[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: 42CFR438.350]



[Page 233]

 

                         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 E_External Quality Review

 

Sec.  438.350  State responsibilities.



    Each State that contracts with MCOs or PIHPs must ensure that--

    (a) Except as provided in Sec.  438.362, a qualified EQRO performs 

an annual EQR for each contracting MCO or PIHP;

    (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 Sec.  438.358.

    (d) For each EQR-related activity, the information must include the 

elements described in Sec.  438.364(a)(1)(i) through (a)(1)(iv);

    (e) The information provided to the EQRO in accordance with 

paragraph (c) of this section is obtained through methods consistent 

with the protocols established under Sec.  438.352; and

    (f) The results of the reviews are made available as specified in 

Sec.  438.364.