The following statements are about standards set forth in the Quality Improvement System for Managed...

As a result of the Balanced Budget Refinement Act (BBRA), PPOs are required to meet all QISMC quality requirements.

QISMC standards typically do not apply to such Medicare services as mental health or substance abuse services.

Medicaid primary care case manager (PCCM) programs are subject to the same QISMC quality standards and performance measures as are all other Medicare and Medicaid programs.

QISMC standards and guidelines are required for Medicare MCOs, but they are applicable to Medicaid MCOs at the discretion of the individual states.