External Quality Review Activities for Family Care

Effective July 1, 2002, the Department contracted with MetaStar to conduct external quality review (EQR) activities for the Family Care program. On an ongoing basis, EQR activities evaluate the quality of the services that are arranged for or provided to Family Care enrollees or potential enrollees under the contract the Department has entered into with MCOs. The goal of EQR activities is to gain an understanding of whether each MCO is or is not in compliance with federal and state requirements that enable it to meet the needs of its enrolled population.

These external quality review activities are performed consistent with applicable Medicaid provisions under Subpart E, 42 CFR 438 and Centers for Medicare and Medicaid Services (CMS) protocols for use in external review of Medicaid managed care organizations and pre-paid health plans.

Annual External Quality Review Reports, Submitted by MetaStar, Inc.

Last Revised: March 13, 2017