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This collection contains external quality reviews that are prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.
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Publication South Carolina External Quality Review: Comprehenisve Technical Report for Contract Year '23-24(2024-04-12) South Carolina Department of Health and Human ServicesThis external quality review was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication Humana Healthy Horizons in South Carolina 2024 external quality review(2024-03-07) South Carolina Department of Health and Human Services; Constellation Quality HealthThe Balanced Budget Act of 1997 requires State Medicaid Agencies that contract with Managed Care Organizations to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations 438.358. This report contains a description of the process and the results of the 2024 External Quality Review that Constellation Quality Health, formerly The Carolinas Center for Medical Excellence, conducted on behalf of the South Carolina Department of Health and Human Services. This review determines the level of performance demonstrated by Humana Healthy Horizons in South Carolina since the 2023 Annual Review.Publication 2023 External quality review - South Carolina Solutions(2023-09-14) South Carolina Department of Health and Human Services Constellation Quality HealthThis external quality review of Absolute Total Care was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication 2023 External quality review - Wellcare Prime by Absolute Total Care(2024-01-04) South Carolina Department of Health and Human Services; Constellation Quality HealthThis external quality review of Wellcare Prime by Absolute Total Care was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication 2023 External quality review - Absolute Total Care(2024-01-04) South Carolina Department of Health and Human Services; Constellation Quality HealthThis external quality review of Absolute Total Care was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication Select Health of South Carolina - 2023 external quality review(2023-10-20) South Carolina Department of Health and Human Services; Constellation Quality HealthThis external quality review of Select Health of South Carolina was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication First Choice VIP Care Plus by Select Health of South Carolina - 2023 external quality review(2023-10-20) South Carolina Department of Health and Human Services; Constellation Quality HealthThis external quality review of First Choice VIP Care Plus by Select Health of South Carolina was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication Healthy Blue by BlueChoice Health Plan of South Carolina - 2023 readiness review(2023-11-08) South Carolina Department of Health and Human Services; Constellation Quality HealthThis external quality review of Healthy Blue by BlueChoice Health Plan of South Carolina was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication 2022 External quality review - Wellcare Prime by Absolute Total Care(2023-03-02) South Carolina Department of Health and Human Services; The Carolinas Center for Medical ExcellenceThis external quality review of Wellcare Prime by Absolute Total Care was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication South Carolina Solutions - 2023 external quality review(2023-09-14) South Carolina Department of Health and Human Services; Constellation Quality HealthThis external quality review of South Carolina Solutions was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication 2023 External quality review - Molina Healthcare of South Carolina : coordinated and integrated care for medicare-medicaid recipients(2023-06-16) South Carolina Department of Health and Human Services; The Carolinas Center for Medical ExcellenceThis external quality review of Molina Healthcare of South Carolina: coordinated and integrated care for medicare-medicaid recipients was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication 2023 External quality review - Molina Healthcare of South Carolina(2023-06-16) South Carolina Department of Health and Human Services; The Carolinas Center for Medical ExcellenceThis external quality review of Molina Healthcare was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication 2023 External quality review- Humana Healthy Horizons in South Carolina(2023-04-05) South Carolina Department of Health and Human Services; The Carolinas Center for Medical ExcellenceThis external quality review of Humana Healthy Horizons was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication 2023 External quality review - Healthy Blue of South Carolina(2023-07-20) South Carolina Department of Health and Human Services; The Carolinas Center for Medical ExcellenceThis external quality review of Healthy Blue of South Carolina was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication South Carolina external quality review - comprehenisve technical report for contract year '22-23(2023-04-21) The Carolinas Center for Medical Excellence; South Carolina Department of Health and Human ServicesThis external quality review was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.Publication 2022 External quality review - Absolute Total Care(2023-03-02) The Carolinas Center for Medical Excellence; South Carolina Department of Health and Human ServicesThis external quality review of Absolute Total Care was prepared on behalf of the South Carolina Department of Health and Human Services. The Balanced Budget Act of 1997 (BBA) requires State Medicaid Agencies that contract with Managed Care Organizations (MCOs) to evaluate their compliance with state and federal regulations in accordance with 42 Code of Federal Regulations (CFR) 438.358.