2009 West Virginia Code
CHAPTER 33. INSURANCE
ARTICLE 25D. PREPAID LIMITED HEALTH SERVICE ORGANIZATION ACT.
§33-25D-19 Quality assurance.
§33-25D-19. Quality assurance.(a) Each prepaid limited health service organization shall have in writing a quality assurance program approved by the commissioner which describes the program's objectives, organization and problem solving activities.
(b) The scope of the quality assurance program shall include, at a minimum:
(1) Organizational arrangements and responsibilities for quality management and improvement processes;
(2) A documented utilization management program;
(3) Written policies and procedures for credentialing and recredentialing physicians and other licensed providers who fall under the scope of authority of the prepaid limited health service organization;
(4) A written policy that addresses enrollees' rights and responsibilities;
(5) The adoption of practice guidelines for the use of preventive health services; and
(6) Any other criteria considered necessary by the commissioner.
(c) This section becomes effective on the first day of May, one thousand nine hundred ninety-nine.
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