Medical Care Evaluation (MCE) Studies Review
All hospital UR plans must provide for a yearly Medical Care Evaluation (MCE) study according to 42 CFR 456.141 – 456.145. The purpose of an MCE study is to promote the most effective and efficient use of available facilities and services, to emphasize identification and analysis of patterns of care and suggest appropriate changes needed to maintain high-quality patient care and efficient use of services.
AFMC requests that completed MCE studies be submitted annually, along with each hospital UR plan. Hospitals will be continuously monitored and reminded to submit the completed MCE studies until all are received. Under program requirements, 50 percent of the completed MCE studies will be reviewed each year so that every hospital study is reviewed every two years. The MCE study plan for the coming year will be reviewed as part of the hospital’s overall UR plan.
A full review of the MCE study will be completed to determine if all requirements under 42 CFR 456.143 – 456.145 are met. Hospitals will receive written notification of review results, and will be given an opportunity to address any identified deficiencies. Results of the AFMC MCE studies review will be reported to the Alabama Medicaid Agency each year, as required under the contract.
Reimbursement for Medical Record Duplication
All providers, upon either verbal or written request from the Alabama Medicaid Agency (AMA) or AFMC (the AMA Inpatient Hospital Quality Assurance Program contractor) shall furnish free of charge a copy of any requested record. If the provider has no copies, the provider must allow the person requesting the copy to check out the original for copying. The provider may require that a receipt be given for any original record removed from their premises.
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