External Quality Review Activities for Family Care

The Wisconsin Department of Health Services (DHS) contracts with MetaStar to conduct external quality review activities for the Family Care, Family Care Partnership, and PACE (Program of All-Inclusive Care for the Elderly) programs. On an ongoing basis, external quality review activities evaluate the quality of the services that are arranged for, or provided to, Family Care enrollees or potential enrollees under the contract DHS enters into with managed care organizations. The goal of the external quality review activities is to gain an understanding of whether each managed care organization is in compliance with federal and state requirements that enable it to meet the needs of its enrollees.

External quality review activities are performed consistent with applicable Medicaid provisions under 42 C.F.R. § 438 and Centers for Medicare & Medicaid Services (CMS) protocols for use in external review of Medicaid managed care organizations and prepaid health plans.

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

Last Revised: April 2, 2021