The Department of Health must establish the rules that govern the performance and outcomes of rural health networks1 and radiation machines.2  

The Department of Children and Family Services’ programs providing mental health treatment and support systems to children must achieve the specific performance outcomes laid out by the department.3

The Agency for Health Care Administration and the Department of Health must make available health care quality measures that allow consumers to compare health care services.4

The local and regional trauma agencies must plan, implement, and evaluate trauma services systems.5 Records and information of a local or regional trauma agency’s quality assurance committee are confidential.6

A hospital, 7 community mental health center,8  trauma center,9 substance abuse services provider,10 rural health network,11 nursing home,12 home health agencies13 must have an ongoing quality assurance program. The Department of Health and the Agency for Health Care Administration must monitor the performance of health care providers to ensure that they meet statutory and regulatory requirements.14 A health care provider may face disciplinary sanctions for interfering with an investigation or inspection authorized by law.15  

A patient has the right to express grievances to a health care facility or provider or to the appropriate state licensing agency.16 Prior to providing services to a patient, a licensed health care facility or provider must inform the patient or the patient’s family or representative of the right to report complaints, abusive, neglectful, or exploitative practices, or Medicaid fraud.17

Each health maintenance organization must have an ongoing internal quality assurance program for its health care services.18 A health maintenance organization must have a process for enrollee grievances and appeals and allow for external appeals.19 Consumers may report satisfaction survey data related to their experiences with their health plan to the Agency for Health Care Administration.20

The Department of Children and Families must also establish a health care quality improvement system for entities contracting with the agency to provide care to Medicaid recipients, incorporating all the standards developed by the Medicaid Bureau of the Health Care Financing Administration as part of the quality assurance reform initiative.21 The Agency for Health Care Administration must enroll in a managed care plan or MediPass all Medicaid recipients.22 Managed care plans participating in the Medicaid program must monitor the quality and performance of each participating provider.23