Quality Measurement and Reporting in Idaho
Quality Measurement and Reporting in Idaho
| Subtopic | Statute/Regulation | Description |
|---|
| Performance measurement for health care providers or insurance plans | Idaho Admin. Code r. 16.02.02.300, EMS Director Authority | Requires the MES medical director to enter a written agreement with an EMS agency to supervise licensed EMS personnel. Permits EMS personnel to... |
| Idaho Admin. Code r. 16.03.09.566, Healthy Connections: Quality Assurance | Requires the Department of Health and Welfare to create performance measures as a means of assessing the effectiveness of the Medicaid primary care... | |
| Idaho Admin. Code r. 16.03.09.567, Children’s Habilitation Intervention Services: Quality Assurance | Requires the Department of Health and Welfare to establish performance measures as a means of assessing the effectiveness of children’s... | |
| Idaho Admin. Code r. 16.07.37.116, Outcomes for Children’s Mental Health Services | Requires the Department of Health and Welfare to measure child’s mental health services outcomes via a standardized functional assessment tool... |
| Quality assurance programs for hospitals or public programs | Idaho Admin. Code r. 16.02.12.200, Laboratory Duties | Requires laboratories that conduct testing on infant blood specimens to participate in the CDC’s Newborn Screening Quality Assurance Program.... |
| Idaho Admin. Code r. 16.03.09.406, Inpatient Hospital Services: Quality Assurance | Requires the designated Quality Improvement Organization (QIO) to create a provider manual that addresses the QIO’s policies and procedures,... | |
| Idaho Admin. Code r. 16.03.09.413, Outpatient Hospital Services: Procedural Requirements | Requires Medicaid providers to obtain a review from a quality improvement organization (QIO) before to providing outpatient hospital services to... | |
| Idaho Admin. Code r. 16.03.09.505, Physician Services: Provider Reimbursement | Imposes a Medicaid reimbursement penalty on physicians that do not obtain a timely Quality Improvement Organization (QIO) review for services that... | |
| Idaho Admin. Code r. 16.03.09.567, Children’s Habilitation Intervention Services: Quality Assurance | Requires the Department of Health and Welfare to establish performance measures as a means of assessing the effectiveness of children’s... | |
| Idaho Admin. Code r. 16.03.09.626, Laboratory and Radiology Services: Quality Assurance | Requires laboratories to maintain a quality-control program that includes proficiency testing as a condition of receiving Medicaid payments. Requires... | |
| Idaho Admin. Code r. 16.03.09.666, Prescription Drugs: Quality Assurance | Tasks the Pharmacy and Therapeutics Committee (P&T Committee) with advising and educating the Idaho Medicaid Pharmacy Program, recommending... | |
| Idaho Admin. Code r. 16.03.09.807, Dental Services: Quality Assurance | Requires providers of dental services to Medicaid participants to comply with the quality assurance guidelines established by the Idaho Smiles... | |
| Idaho Admin. Code r. 16.03.10.308, Personal Care Services: Quality Assurance | Requires personal care service (PCS) providers to furnish quality services. Requires the Department of Health and Welfare to deliver the results of... | |
| Idaho Admin. Code r. 16.03.10.329, Aged and Disabled Waiver Services: Provider Qualifications and Duties | Establishes standards for providers of aged and disabled waiver services. Requires these providers to comply with applicable quality assurance rules... | |
| Idaho Admin. Code r. 16.03.10.515, Adult Developmental Disability Services: Quality Assurance and Improvement | Requires providers of adult developmental disability services to implement a corrective action plan within 45 days of the Department of Health and... | |
| Idaho Admin. Code r. 16.03.10.525, Children’s DD HCBS State Plan Option: Procedural Requirements | Requires children’s DD HCBS services to receive prior authorization. Requires providers of HCBS services to assure quality services by... | |
| Idaho Admin. Code r. 16.03.10.528, Children’s DD HCBS State Plan Option: Department’s Quality Assurance and Improvement Processes | Requires the Department of Health and Welfare to conduct quality assurance reviews and audits of DD HCBS services providers. Defines permissible... | |
| Idaho Admin. Code r. 16.03.13.200, Quality Assurance | Requires the Department of Health and Welfare to establish a quality assurance process for ICFs/ID as a means of assuring patient-centered care and... | |
| Idaho Admin. Code r. 16.03.14.200, Governing Body and Administration | Requires licensed hospitals to be run by a governing body. Establishes minimum bylaws that the governing body must adopt. Requires the hospital... | |
| Idaho Admin. Code r. 16.07.15.330, Quality Assurance | Requires behavioral health programs to establish a quality assurance plan that addresses items such as staff training, regulatory compliance,... | |
| Idaho Code Ann. § 39-1392f, Peer Review | Requires hospitals subject to the Chapter 39 licensing laws to establish a peer review committee in order to assess the quality and necessity of... | |
| Idaho Code Ann. § 56-1030, Regional Time Sensitive Emergency Committees | Requires each substate region, as designated by the Time Sensitive Emergency Council, to establish a committee. Tasks the committee with conducting... | |
| Idaho Code Ann. § 56-1054, Health Quality Planning | Establishes the Health Quality Planning Commission (“Commission”) within the Department of Health and Welfare (“Department... | |
| Idaho Code Ann. § 57-2001, Purpose of Registry | Specifies the issues that the Time Sensitive Emergency (TSE) Registry is meant to identify and evaluate (e.g., trauma, stroke, and heart attack... |
| Delivery system reforms to promote and measure health care quality (ACOs/health homes) (Cross reference Care Coordination) | Idaho Admin. Code r. 16.03.09.561, Healthy Connections: Participant Eligibility | Requires Idaho Medicaid participants to enroll in the Healthy Connections program unless the Department of Health and Welfare provides an exemption.... |
| Idaho Admin. Code r. 16.03.09.562, Healthy Connections: Primary Care Services | Defines the services that Healthy Connections participants who are enrolled with a primary care provider may receive (e.g., care management and... | |
| Idaho Admin. Code r. 16.03.09.563, Healthy Connections: Procedural Requirements | Requires the Department of Health and Welfare to provide 60 days notice to providers of any changes to the Healthy Connections program. Requires the... | |
| Idaho Admin. Code r. 16.03.09.564, Healthy Connections: Provider Qualifications and Duties | Permits physicians, physician assistants, advanced practice register nurses, and their care teams to provide primary care services to Healthy... | |
| Idaho Admin. Code r. 16.03.10.296, Nursing Facility: Quality Incentives | Authorizes the Department of Health and Welfare to issue incentive payments to nursing facility providers that provide quality care. Permits the... |
| Grievance programs (Reporting requirements, Management of grievance reports) | Idaho Admin. Code r. 16.03.09.563, Healthy Connections: Procedural Requirements | Requires the Department of Health and Welfare to provide 60 days notice to providers of any changes to the Healthy Connections program. Requires the... |
| Idaho Admin. Code r. 16.03.09.711, Outpatient Behavioral Health Services: Procedural Requirements | Requires providers that wish to provide outpatient behavioral health services to Medicaid participants to enroll with the contractor that administers... | |
| Idaho Admin. Code r. 16.03.09.804, Dental Services: Procedural Requirements | Requires dental services providers to enroll in the Idaho Smiles network in order to receive Medicaid reimbursement. Assigns responsibility for... | |
| Idaho Admin. Code r. 16.03.14.225, Patient Grievances | Defines ‘patient grievance’ as formal or informal complaint made to the hospital about abuse, neglect, the hospital’s compliance... | |
| Idaho Admin. Code r. 16.07.15.370, Participant Rights | Requires behavioral health programs to establish a written statement of participant rights and identifies the rights that the statement must include... | |
| Idaho Admin. Code r. 22.01.01.165, Supervising Physicians of Medical Personnel | Defines the administration of prescriptive medical/cosmetic devices and products (e.g., collagen injections, liposuction, etc.) as the practice of... | |
| Idaho Code Ann. § 41-3918, Grievance System | Requires Managed Care Organizations (MCOs) to implement a grievance system that has received approval from the Insurance Director. Requires MCOs to... | |
| Idaho Code Ann. § 41-5914, External Review Reporting Requirements | Requires independent review organizations to maintain records of requested and assigned external reviews. Specifies the data that such organizations... | |
| Idaho Code Ann. § 41-5916, Disclosure Requirements | Specifies the information about external review procedures that health carriers must include in policies, certificates, and other evidences of... |
| Use and availability of Patient satisfaction surveys/Facility compliance surveys | Idaho Admin. Code r. 16.03.09.567, Children’s Habilitation Intervention Services: Quality Assurance | Requires the Department of Health and Welfare to establish performance measures as a means of assessing the effectiveness of children’s... |
| Idaho Admin. Code r. 16.03.13.200, Quality Assurance | Requires the Department of Health and Welfare to establish a quality assurance process for ICFs/ID as a means of assuring patient-centered care and... | |
| Idaho Admin. Code r. 16.07.37.116, Outcomes for Children’s Mental Health Services | Requires the Department of Health and Welfare to measure child’s mental health services outcomes via a standardized functional assessment tool... |
| Quality reporting requirements – providers and health plans | Idaho Admin. Code r. 16.03.10.515, Adult Developmental Disability Services: Quality Assurance and Improvement | Requires providers of adult developmental disability services to implement a corrective action plan within 45 days of the Department of Health and... |
| Reporting, Use and/or Confidentiality of quality data (Cross reference Privacy & Confidentiality) | Idaho Code Ann. § 39-3123, Designation of State Mental Health Authority and State Substance Use Disorder Authority | Designates the Department of Health and Welfare as the state behavioral health authority (“Authority”) and tasks the Authority with... |
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