33-36-303. Standards for health carrier quality improvement programs.
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33-36-303 . Standards for health carrier quality improvement programs. A health carrier that issues a closed plan or a combination plan shall, in addition to complying with 33-36-302 , adopt and use systems and methods necessary to improve the quality of health care provided in the health carrier's managed care plan as indicated by the health carrier's quality assessment program and as required by this section. To comply with this requirement, a health carrier subject to this section shall:
(1)establish an internal system capable of identifying opportunities to improve care;
(2)use the findings generated by the system required by subsection
(1)to work on a continuing basis with participating providers and other staff within the closed plan or closed component to improve the health care delivered to covered persons; and
(3)consistent with this part, adopt and use a program for measuring, assessing and improving the outcomes of health care as identified in the health carrier's quality improvement program plan and provide at the commissioner's request a current quality improvement program plan. The quality improvement program plan must:
(a)implement improvement strategies in response to quality assessment findings that indicate improvement is needed; and
(b)evaluate, not less than annually, the effectiveness of the strategies implemented pursuant to subsection (3)(a).