Minn. Stat. § 256B.0651, subd. 15 and subd. 16, Minn. Stat. §256B.0652

Quality assurance (QA): Guarantee of program integrity through review of the services reimbursed by Medicaid/Medical Assistance, a combination of state and federal government funds.

State and federal legislation provides DHS the authority and responsibility to:

QA is a support and assistance process to identify areas that need improvement in order to provide the most effective and efficient services to people.

The ongoing QA process monitors standards through a use of a variety of tools, including but not limited to training and testing, surveys, data collection and scheduled and random reviews of records.

Numerous methods are used, such as requesting information to be sent to DHS, visiting sites, using self-reports and analyzing data available from various sources.

Cooperation from those providing direct services is essential for this compliance

DHS is responsible to develop and implement a system for continuous performance measurement for the assessment and delivery of services to ensure specific technical and/or procedural requirements are met.

DHS will monitor, review and measure the following:

The lead agency is responsible to:

The managed care organization (MCO) is responsible to establish an internal quality assurance program.

The PCA provider agency is responsible to provide access to all agency records and documentation, including:

The PCA provider agency must demonstrate compliance with all laws, rules and policies.