External Quality Review: An Overview

External Quality Review: An Overview

Executive Summary

Part of the overall quality strategy mandated by the Medicaid Act and regulations requires states to include annual independent external quality reviews (EQRs) in each managed care contract. This approach requires an independent organization to validate state selected performance measures, perform site visits and “otherwise evaluate the performance of Medicaid managed care plans.”

This brief reviews the EQR requirements, explores their strengths and shortcomings in current practices, and recommends several changes to strengthen the EQR process and improve transparency.

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