500.3508 Quality assessment program; quality improvement program.
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500.3508 Quality assessment program; quality improvement program.
Sec. 3508.
(1)A health maintenance organization shall develop and maintain a quality assessment program that includes, at a minimum, systematic collection, analysis, and reporting of relevant data in accordance with statutory and regulatory requirements.
(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 place the quality improvement program under the direction of its medical director and include all of the following in the program:
(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 ;-- Am. 2016, Act 276 , Imd. Eff. July 1, 2016
Popular Name: Act 218
Popular Name: HMO