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DHCF CY 2011-2012 Managed Care Organization Technical Report

Thursday, May 2, 2013
DHCF contracts with the Delmarva Foundation for Medical Care, Inc. (Delmarva) to serve as the external quality review organization (EQRO).

Federal regulations require that states contracting with managed care plans ensure that organizations, independent of both the District and the managed care plans perform an annual external review of the quality, timeliness and access to health care services furnished by each managed care plan. In fulfillment of this requirement, DHCF contracts with the Delmarva Foundation for Medical Care, Inc. (Delmarva) to serve as the external quality review organization (EQRO). This report describes the review activities conducted by Delmarva, the methods used to aggregate and analyze information from the review activities, and draws conclusions as to the quality, timeliness, and access to healthcare services furnished by Medicaid managed care plans in the District of Columbia during CY 2011-2012.