5160-26-07 Managed health care programs: annual external quality review survey.

(A) ODJFS will select an external quality review organization (EQRO) to provide for an annual, external, and independent review of the quality, outcomes, timeliness of and access to services provided by managed care plans (MCPs).

(B) MCPs must participate in external quality review activities as specified by 42 C.F.R. 438.358 and ODJFS.

(C) MCPs must timely submit data and information, including member medical records, at no cost to the member or ODJFS, as requested by ODJFS or its designee for the annual external quality review.

Replaces: 5101:3-26-07

Effective: 10/01/2011
R.C. 119.032 review dates: 10/01/2016
Promulgated Under: 119.03
Statutory Authority: 5111.02 , 5111.16 , 5111.17
Rule Amplifies: 5111.01 , 5111.02 , 5111.16 , 5111.17
Prior Effective Dates: 4/1/85, 5/2/85, 10/1/87, 2/15/89 (Emer), 5/8/89, 11/1/89 (Emer), 2/1/90, 5/1/92, 5/1/93, 11/1/94, 7/1/96, 7/1/97 (Emer), 9/27/97, 7/1/01, 7/1/02, 7/1/03, 7/1/04, 10/31/05, 6/1/06, 1/1/07, 1/1/08, 9/15/08