Library: Policy

317:55-5-41. Accountable care organization, duties

Issued 12-21-21

(a) Any MCO or DBM that contracts with an ACO will retain full responsibility as to all terms of the MCO's or DBM's managed care contract with OHCA.

(b) The MCO or DBM will track and report quality metrics of any contracted ACO in accordance with the terms of the MCO's or DBM's managed care contract with OHCA.

(c) The MCO or DBM will timely and accurately collect and analyze data related to patient utilization and costs. All such data and analysis will be shared with OHCA.

(d) The MCO or DBM in coordination with the ACO must use collected data to improve quality and target patients for care management interventions and program.