42 CFR 438.350
§ 438.350 External quality review.
United States · 42 CFR — Public Health · Status: effective
Cite this
- Citation
- 42 CFR 438.350, § 438.350 External quality review, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/206135
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Full text
Each State that contracts with MCOs, PIHPs, or PAHPs must ensure that—
(a) Except as provided in § 438.362, a qualified EQRO performs an annual EQR for each such contracting MCO, PIHP, or PAHP.
(b) The EQRO has sufficient information to use in performing the review.
(c) The information used to carry out the review must be obtained from the EQR-related activities described in § 438.358 or, if applicable, from a Medicare or private accreditation review as described in § 438.360.
(d) For each EQR-related activity, the information gathered for use in the EQR must include the elements described in § 438.364(a)(2)(i) through (iv).
(e) The information provided to the EQRO in accordance with paragraph (b) of this section is obtained through methods consistent with the protocols established by the Secretary in accordance with § 438.352.
(f) The results of the reviews are made available as specified in § 438.364.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.