(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 May 1, 1999.
Structure West Virginia Code
Article 25D. Prepaid Limited Health Service Organization Act
§33-25D-3. Application for Certificate of Authority; Addition of Services
§33-25D-5. Issuance of Certificate of Authority
§33-25D-7. Powers of Organization
§33-25D-8. Governing Body; Enrollee Participation
§33-25D-9. Fiduciary Responsibilities of Managers; Fidelity Bond
§33-25D-10. Provider Contracts
§33-25D-12. Annual and Quarterly Reports
§33-25D-13. Annual Report to Enrollees
§33-25D-14. Grievance Procedure
§33-25D-15. Prohibited Practices
§33-25D-16. Agent Licensing and Appointment Required; Regulation of Marketing
§33-25D-20. Suspension or Revocation of Certificate of Authority
§33-25D-23. Administrative Procedures
§33-25D-25. Penalties and Enforcement
§33-25D-26. Scope of Provisions; Applicability of Other Laws
§33-25D-27. Filings and Reports as Public Documents
§33-25D-28. Confidentiality of Medical Information
§33-25D-29. Authority to Contract With Prepaid Limited Health Service Organizations Under Medicaid