Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 5. Department of Health
Chapter 408. Certificate of Quality Assurance of Managed Care Health Insurance Plan Licensees

12VAC5-408-310. Data collection and submission.

A. Data collected and analyzed for clinical service evaluation shall be:

1. From the covered person population areas appropriate for the MCHIP to assess including: (i) high risk and high volume areas, (ii) areas where clinical problems are expected or have occurred in the past, (iii) areas that have the potential for adverse health outcomes, and (iv) areas where preventive health measures may have an impact;

2. Collected using processes that are methodologically sound;

3. Valid, reliable, complete and timely;

4. Analyzed quantitatively by personnel qualified to evaluate the data for clinical quality improvement; and

5. Protected for confidentially, easily retrievable, and transmitted for appropriate release to external parties.

B. The MCHIP licensee may permit appropriate organizations with which it contracts to collect and analyze relevant performance evaluation data and to release that data to the department or to its designee.

Statutory Authority

§ 32.1-137.1 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 16, Issue 7, eff. January 20, 2000; amended, Virginia Register Volume 18, Issue 8, eff. January 30, 2002.

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