External Quality Reviews

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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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Now showing 1 - 5 of 15
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    Humana Healthy Horizons in South Carolina 2024 external quality review
    (2024-03-07) South Carolina Department of Health and Human Services; Constellation Quality Health
    The 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.
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    2023 External quality review - South Carolina Solutions
    (2023-09-14) South Carolina Department of Health and Human Services Constellation Quality Health
    This 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.
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    2023 External quality review - Wellcare Prime by Absolute Total Care
    (2024-01-04) South Carolina Department of Health and Human Services; Constellation Quality Health
    This 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.
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    2023 External quality review - Absolute Total Care
    (2024-01-04) South Carolina Department of Health and Human Services; Constellation Quality Health
    This 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.
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    Select Health of South Carolina - 2023 external quality review
    (2023-10-20) South Carolina Department of Health and Human Services; Constellation Quality Health
    This 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.