Chapter 408. Certificate of Quality Assurance of Managed Care Health Insurance Plan LicenseesRead Chapter
- Part I.Read allDefinitions and General Information
- Section 10
- Definitions
- Section 20
- Responsibility of the department
- Section 30
- Certificate of quality assurance
- Section 40
- Fees
- Section 50
- Compliance provisions appropriate for type of plan
- Section 60
- General examination process
- Section 70
- Administrative review
- Section 80
- Renewal application
- Section 90
- Comprehensive onsite examination
- Section 100
- Examination by a nationally recognized accreditation organization
- Section 110
- Corrective action procedures
- Section 120
- Changes to geographic service areas
- Section 130
- Complaint system, complaint examination and investigation
- Section 140
- Administrative sanctions
- Section 150
- Surrender of certificate
- Part II.Read allAdministrative Services
- Section 160
- Management and administration
- Section 170
- Provider credentialing and recredentialing
- Section 180
- Complaint system
- Section 190
- Covered person education and communication
- Section 200
- Data management
- Section 210
- Medical records
- Part III.Read allQuality Improvement Program
- Section 220
- Purpose
- Section 230
- Program requirements
- Section 240
- Quality assurance plan
- Part IV.Read allCoordination and Continuity of Care
- Section 250
- Continuity of care
- Section 260
- Network adequacy
- Section 270
- Travel and appointment waiting times
- Section 280
- Urgent care and emergency services
- Section 290
- Health promotion
- Part V.Read allClinical Performance Evaluation
- Section 300
- Clinical performance evaluation systems
- Section 310
- Data collection and submission
- Part VI.Read allDelegated Services
- Section 320
- Delegated services
- Section 330
- Written agreement
- Section 340
- Exchange of information
- Section 350
- Quality assurance program
- Part VII.Read allUtilization Review and Management
- Section 360
- Utilization review and management