EXTERNAL QUALITY REVIEW ORGANIZATION SERVICES
HSAG performs the following EQRO services:
- Review of Health Plan Compliance with Managed Care Standards, Review of Corrective Action Plans, and Re-evaluation of Corrective Actions
- Validation of Performance Improvement Projects
- Validation of Performance Measures and HEDIS Report Validation
- Administration of Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Surveys
- Administration of Provider Satisfaction Surveys
- Development of an Annual Report of External Quality Review Activity Results
- Technical Assistance to the State and the Health Plans
PEER REVIEW SERVICES
Long Term Care Level of Care (LOC) and At Risk Determinations
HSAG conducts LOC determinations on requests submitted by the QUEST Integration health plans and community providers for Medicaid members requiring nursing facility (NF) level of care or who are at risk of deteriorating to the NF LOC. HSAG maintains an electronic data base of requests and determinations in “HILOC” – a secure Web application available to Hawaii Medicaid health plans and their contracted Medicaid providers.
Pre-Admission Screening and Resident Review (PASRR) Compliance Reviews
HSAG conducts reviews on a quarterly sample of admissions to Medicaid-certified nursing facilities in the state of Hawaii for compliance with the PASRR process.
Acute Hospital and Ambulatory Surgery Center Reviews
HSAG conducts retrospective quality and utilization reviews annually on a sample of Medicaid paid claims or encounters for services provided in acute hospital or ambulatory surgery settings.
For more information about the Hawaii PRO services, contact Elizabeth Marsh, Associate Director, at email@example.com.