Section 500.3508 - Quality assessment program; quality improvement program.
THE INSURANCE CODE OF 1956 (EXCERPT)
Act 218 of 1956
500.3508 Quality assessment program; quality improvement program.
Sec. 3508.
(1) A health maintenance organization shall develop and maintain a quality assessment program to assess the quality of health care provided to enrollees that includes, at a minimum, systematic collection, analysis, and reporting of relevant data in accordance with statutory and regulatory requirements. A health maintenance organization shall make available its quality assessment program as prescribed by the commissioner.
(2) A health maintenance organization shall establish and maintain a quality improvement program to design, measure, assess, and improve the processes and outcomes of health care as identified in the program. A health maintenance organization shall make available its quality improvement program as prescribed by the commissioner. The quality improvement program shall be under the direction of the health maintenance organization's medical director and shall include:
(a) A written statement of the program's objectives, lines of authority and accountability, evaluation tools, including data collection responsibilities, and performance improvement activities.
(b) An annual effectiveness review of the program.
(c) A written quality improvement plan that, at a minimum, describes how the health maintenance organization analyzes both the processes and outcomes of care, identifies the targeted diagnoses and treatments to be reviewed each year, uses a range of appropriate methods to analyze quality, compares program findings with past performance and internal goals and external standards, measures the performance of affiliated providers, and conducts peer review activities.
History: Add. 2000, Act 252, Imd. Eff. June 29, 2000
Popular Name: Act 218
Popular Name: HMO