42 CFR § 438.350 - External quality review.

---
identifier: "/us/cfr/t42/s438.350"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 438.350 - External quality review."
title_number: 42
title_name: "Public Health"
section_number: "438.350"
section_name: "External quality review."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "C"
subchapter_name: "MEDICAL ASSISTANCE PROGRAMS"
part_number: "438"
part_name: "MANAGED CARE"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302."
regulatory_source: "67 FR 41095, June 14, 2002, unless otherwise noted."
cfr_part: "438"
---


# 438.350 External quality review.

Each State that contracts with MCOs, PIHPs, or PAHPs must ensure that—

(a) Except as provided in § 438.362, a qualified EQRO performs an annual EQR for each such contracting MCO, PIHP, or PAHP.

(b) The EQRO has sufficient information to use in performing the review.

(c) The information used to carry out the review must be obtained from the EQR-related activities described in § 438.358 or, if applicable, from a Medicare or private accreditation review as described in § 438.360.

(d) For each EQR-related activity, the information gathered for use in the EQR must include the elements described in § 438.364(a)(2)(i) through (iv).

(e) The information provided to the EQRO in accordance with paragraph (b) of this section is obtained through methods consistent with the protocols established by the Secretary in accordance with § 438.352.

(f) The results of the reviews are made available as specified in § 438.364.

[81 FR 27853, May 6, 2016, as amended at 82 FR 39, Jan. 3, 2017; 89 FR 41278, May 10, 2024]