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 218Popular Name: HMO
Structure Michigan Compiled Laws
Chapter 500 - Insurance Code of 1956
Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)
218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)
Section 500.3501 - Definitions.
Section 500.3503 - Applicability of Provisions to Health Maintenance Organization.
Section 500.3505 - Health Maintenance Contract; Use of Descriptive Words; Restrictions.
Section 500.3508 - Quality Assessment Program; Quality Improvement Program.
Section 500.3509 - Certificate of Authority; Application; Form; Limitation; Change of Service Area.
Section 500.3511 - Governing Body; Election of Enrollee Board Members; Requirements; Meetings.
Section 500.3521 - Prepayment Rates; Filing and Approval of Methodology; Schedule.
Section 500.3523 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3527 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3535 - Solicitation or Advertising.
Section 500.3537 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3539 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3541 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3542 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3543 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3544 - Noninsured Benefit Plan; Processing and Payment of Claims.
Section 500.3545 - Acquisition of Obligations From Another Managed Care Entity.
Section 500.3548 - Maintenance of Books, Records, Files, and Financial Records; Funds and Assets.
Section 500.3549 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3551 - Health Maintenance Organization; Net Worth.
Section 500.3553 - Certificate of Authority; Deposit Requirements.
Section 500.3555 - Financial Plan.
Section 500.3557 - Notice of Changes in Operations.
Section 500.3561 - Insolvency; Continuation of Benefits.
Section 500.3565 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3567 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3569 - Assumption of Financial Risk.
Section 500.3571 - State or Federal Health Programs.
Section 500.3580 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.