Qlarant performed, on an annual basis, an external, independent review of quality outcomes of timeliness, and access to, the services provided to Health Steps recipients, as outlined in 42 CFR 438, Subpart E. Health Steps is the State’s stand-alone Medicaid Expansion plan providing full Medicaid benefits to eligible children. Qlarant was responsible for performing mandatory and optional activities for each MCO. Mandatory activities included:
a) validation of performance improvement projects;
b) validation of performance measures reported as required by the State of North Dakota; and
c) a review, conducted within the previous three year period, to determine compliance with standards established by the State with regards to access to care, structure and operations, and quality measurement and improvement.
Optional activities as required by the state included the provision of technical assistance to the MCO to assist in conducting activities related to the EQR activities.
Qlarant’s annual detailed technical report describes data aggregation and analysis, and the conclusions that were drawn regarding the quality, timeliness, and access to the care furnished by the MCO. The report also included:
a) assessment of the MCO’s strengths and opportunities for improvement;
b) recommendations for improving quality of health care;
c) comparative information about the MCO, and
d) evaluation of how effectively the MCO addressed the improvement recommendations made by the EQRO the prior year.
