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Quality and Performance

Counties participating in the Drug Medi-Cal Organized Delivery System (DMC-ODS) are considered Prepaid Inpatient Health Plans (PIHP) and therefore subject to applicable Medi-Cal Managed Care laws and regulations governed by the Centers for Medicare and Medicaid Services (CMS).  The regulations include many requirements designed to ensure beneficiaries receive high quality services without barriers to access.  Counties are required to have in place a network of providers adequate to meet the needs of the beneficiaries, and conduct ongoing quality improvement and utilization review activities. These activities can include reviewing the providers’ use of required evidence based practices, practice guidelines, and utilization of services.

At the State level, DHCS is required to have a written strategy for assessing and reporting the quality of services offered by DMC-ODS counties. In conjunction with this quality strategy, DHCS monitors the Plans annually for compliance with regulations and/or requirements. Information on requirements and results of monitoring activities are found below.

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