# Medicaid Program; External Quality Review of Medicaid Managed Care Organizations
> **Centers for Medicare and Medicaid Services** · Final rule. · Published 2003-01-24 · Effective 2003-03-25 · 68 FR 3586
## Document
- **Document number:** 03-1294
- **Category:** medicare
- **Sub-agency:** Centers for Medicare and Medicaid Services
- **Federal Register citation:** 68 FR 3586
- **CFR reference:** 42 CFR 433
- **Publication date:** 2003-01-24
- **Effective date:** 2003-03-25
- **HHS docket:** CMS-2015-F
## Abstract

This final rule establishes requirements and procedures for external quality review (EQR) of Medicaid managed care organizations (MCOs) and prepaid inpatient health plans (PIHPs). It defines who qualifies to conduct EQR and what activities can be conducted as part of EQR. In addition, under certain circumstances, this rule allows State agencies to (1) use findings from particular Medicare or private accreditation review activities to avoid duplicating review activities, or (2) exempt certain Medicare MCOs and PIHPs from all EQR requirements. Also, this rule allows the payment of enhanced Federal financial participation (FFP) at the 75 percent rate for the administrative costs of EQRs or EQR activities that are conducted by approved entities.

## Source
- [Federal Register document](https://www.federalregister.gov/documents/2003/01/24/03-1294/medicaid-program-external-quality-review-of-medicaid-managed-care-organizations)
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