R382-3-3. Performance Measures

An MCO that contracts with the department to provide services to CHIP members shall report the following information to the department in accordance with the terms of its contract: (1) emergency room visits with low acuity CPT codes 99281or 99282; (2) actions the MCO takes to expand primary care and urgent care for CHIP members who are enrolled in the managed care plan; (3) actions the MCO takes to implement emergency room diversion plans that include weekday, evening, and weekend access to primary care providers and community health centers for CHIP members, other innovations for expanding access to primary care; and (4) other quality of care for CHIP members who are enrolled in an MCO as required by the department.