Empower Healthcare Solutions (Empower) providers are informed that the Arkansas Department of Human Services (DHS) has contracted with Qsource, an external quality review organization (EQRO), to conduct external quality review (EQR) activities for managed care organizations (MCOs), including Provider-Led Arkansas Shared Savings Entity (PASSE). This compliance assessment is required by the Balanced Budget Act of 1997 and codified in the Code of Federal Regulations (CFR), Title 42, section 438.
The review scope includes PASSE compliance with relevant CFR requirements and contract provisions related to those regulations. The review period will be for the previous year, and EQRO will complete a desk review of the documentation provided by each PASSE. After the desk review is complete, Qsource will conduct a one-day on-site review to interview key PASSE personnel, clarify documentation, and observe system demonstrations as needed.
Each standard is composed of multiple elements that have an assigned point value, with the total possible value of all standards/elements totaling 35 points. Qsource will calculate a compliance percentage for each standard and an overall percentage score across standards. Complaint, grievance, and appeal file reviews will be scored separately.
Qsource will complete a draft report of assessment scores, findings, and recommendations. PASSEs will have five business days to review the draft reports and provide feedback regarding potential factual inaccuracies. Following DHS review of the reports and PASSE feedback, Qsource will update the draft reports as needed and post a final 2022 Annual Compliance Assessment Report for each Plan.
Empower Healthcare Solutions (Empower) providers should ensure that they are complying with all relevant CFR requirements and contract provisions related to those regulations. This external quality review will help identify areas for improvement and ensure that PASSEs are meeting the required standards for access to care, structure and operations, and quality measurement and improvement. Empower providers should be prepared to provide documentation and participate in interviews during the on-site review. By working collaboratively with Qsource and DHS, Empower can continue to provide high-quality care to their patients.