Practice Quiz

Managed Care Nursing

Category - Healthcare Economics

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According to Federal regulation42 CFR 438.200 (which refers to quality requirements in contracting with MCO or PHIP) which statement is incorrect?

The State is responsible for:
  1. Assessing the MCO or PHIP quality strategy
  2. Perform a EQR of MCO or PHIP
  3. A written strategy for assessing quality improvement of MCO or PHIP services
  4. States may contract with EQRO to perform EQR
Explanation
Answer: A- The State is not responsible for assessing the MCO or PHIP quality strategy.

There are two quality activities or requirements for states in contracting with MCO or PHIP. The state is responsible for a written strategy for assessing quality improvement of MCO or PHIP services and performing an EQR of MCO or PHIP or contract with EQRO to perform EQR.
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