DHS 10.44(3)(d)(d) Maintain a process to consider an enrollee’s request to receive services from a provider who does not have an agreement with the CMO for providing services to the CMO’s enrollees. The CMO shall arrange for services with non-CMO providers if the enrollee’s request is authorized by the CMO. Instances where the enrollee’s request for a non-CMO provider is warranted include all of the following: DHS 10.44(3)(d)1.1. When the CMO does not have the capacity to meet the identified needs of its enrollees. DHS 10.44(3)(d)2.2. When the CMO does not have the specialized expertise, specialized knowledge or appropriate cultural diversity in its network of providers. DHS 10.44(3)(d)4.4. When transportation or physical access to the CMO providers causes an undue hardship to the enrollee. DHS 10.44(3)(e)(e) Offer each enrollee the opportunity to participate in the monitoring and improvement of services in the enrollee’s care plan. DHS 10.44(4)(4) Internal quality assurance and quality improvement. The CMO shall implement an internal quality assurance and quality improvement program that [meets] the requirements of its contract with the department. As part of the program, the CMO shall do all of the following: DHS 10.44(4)(a)(a) Measure CMO performance, using standard measures as required in its contract with the department, and report its findings on these measurements to the department. DHS 10.44(4)(b)(b) Demonstrate, through the standard measures agreed to in its contract with the department, that the CMO meets or exceeds minimum performance standards and that the CMO is continuously improving its performance in achieving enrollee outcomes in all of the areas specified in sub. (2) (e) 2. DHS 10.44(4)(c)(c) Comply with the standards for quality of services included in the CMO’s contract with the department in all of the following areas: DHS 10.44(4)(c)1.1. Availability of services and adequacy of the CMO’s provider network. DHS 10.44(4)(c)5.5. Protection of enrollee rights, including processes for protecting confidentiality and for acting on and resolving grievances and appeals. DHS 10.44(4)(c)6.6. Mechanisms to detect and correct both underutilization and overutilization of services. DHS 10.44(4)(d)(d) Develop and implement a written quality assurance and quality improvement plan designed to ensure and improve outcomes for its target population. The plan shall be approved by the department and shall include at least all of the following components: DHS 10.44(4)(d)1.1. Identification of performance goals, specific to the needs of the CMO’s enrollees, including any goals specified by the department. DHS 10.44(4)(d)2.2. Identification of objective and measurable indicators of whether the identified goals are being achieved, including any indicators specified by the department. DHS 10.44(4)(d)3.3. Identification of timelines within which goals for improvement will be achieved. DHS 10.44(4)(d)4.4. Description of the process that the CMO will use to gather feedback from enrollees, staff, people who have disenrolled from the CMO and other sources on the quality and effectiveness of the CMO’s performance. DHS 10.44(4)(d)5.5. A description of the process the CMO will use to monitor and act on the results and feedback received. DHS 10.44(4)(d)6.6. A process for regularly updating the plan, including a description of the process the CMO will use for annually assessing the effectiveness of the quality assurance and quality improvement plan and the impact of its implementation on outcomes. DHS 10.44(4)(e)(e) Conduct, as specified in its contract with the department, at least one performance improvement project annually that examines aspects of care and services related to improving CMO quality and enrollee outcomes. Each project shall include all of the following: DHS 10.44(4)(e)4.4. Planning for sustained or increased improvement in performance, based on the findings of the evaluation. DHS 10.44(4)(f)(f) Report all data required by the department related to standardized measures of performance, in the timeframes and format specified by the department.