Sec. 503. State quality review programs
232 words·~1 min read·
/bill/113/hr/1200/ih/section-503·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
In order to meet the requirement of section 404(b)(1)(H), each State health security program shall establish 1 or more qualified entities to conduct quality reviews of persons providing covered services under the program, in accordance with standards established under subsection (b)(1) (except as provided in subsection (b)(2)) and subsection (d). The Council shall establish standards with respect to— the adoption of practice guidelines (whether developed by the Federal Government or other entities); the identification of outliers (consistent with methodologies adopted under section 502(a)); the development of remedial programs and monitoring for outliers; and the application of sanctions (consistent with the standards developed under section 502(c)).
A State may apply under subsection
(a)standards other than those established under paragraph
(1)so long as the State demonstrates to the satisfaction of the Council on an annual basis that the standards applied have been as efficacious in promoting and achieving improved quality of care as the application of the standards established under paragraph (1). Positive improvements in quality shall be documented by reductions in the variations of clinical care process and improvement in patient outcomes. An entity is not qualified to conduct quality reviews under subsection
(a)unless the entity satisfies the criteria for competence for such entities developed by the Council under section 501(b)(3). Nothing in this section shall preclude an institutional provider from establishing its own internal quality review and enhancement programs.