EQROExternal Quality Review Organization
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(170) The MCO's PIPs are subject to review and validation by the EQRO. (171)
(172) AHCA has dictated the MCO's responsibility regarding reporting to the EQRO in the contracts, but the State is ultimately responsible for oversight and monitoring.
MAA collects HEDIS[R] results from MCOs, conducts studies with the EQRO, and sponsors a statewide survey using the CAHPS[R] and FAACT survey instruments.
In the worst cases, States placed staff at the plans to help overcome problems or had the EQRO work closely with the plan.
All have contracted with an EQRO to conduct special studies; some have used the EQRO for additional activities (which are described in this and later sections).
Table 4 Quality Assurance Program Monitoring, by State Activity Hawaii Oklahoma Who monitors quality Demonstration EQRO assurance programs?
Oklahoma's EQRO studied birth outcomes and found that plans improved rates of prenatal care in the first trimester between 1995 and 1996, but that females still were not receiving the number of visits recommended by the American College of Obstetricians and Gynecologists (State of Oklahoma, 1997).
Hawaii and Rhode Island waited until 2 years into their demonstrations to select EQRO contractors to conduct focused studies, even though it was a Federal requirement to have an external auditor.