N.J. Admin. Code § 11:24-3.8

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:24-3.8 - Submission of documents and data

(a) The HMO shall submit all membership, utilization, financial, and descriptive plan information to the Department as requested. This shall include, but is not limited to:

1. A quarterly report on forms prescribed by the Department and specified at 11:24-11.6(d). This report shall be submitted within 45 days after the end of each quarter; and

2. An annual report, a current directory of providers, and a record of all member and provider complaints, inclusive of all malpractice actions, on forms prescribed by the Department, as specified at 11:24-11.6. These reports shall be submitted by March 1 of the following year. The record of member and provider complaints referred to above shall include at least the following:

i. The total number of complaints and utilization management appeals filed within the last year, categorized by cause and disposition;

ii. The average length of time for resolution of each complaint and utilization management appeal by cause or category; and

iii. The number, amount and disposition of malpractice claims settled or adjudicated during the year in which the HMO was a named party to the suit.

(b) The HMO shall submit a copy of its internal performance indicators to the Department on an annual basis.

(c) The HMO shall submit continuous quality improvement information as required in N.J.A.C. 11:24-7 to the Department, including, but not limited to:

1. A copy of the continuous quality improvement plan and all subsequent revisions to the plan on an annual basis;

2. A copy of the reports from the continuous quality improvement plan submitted to the Board of Directors on an annual basis;

3. A copy of the performance and outcome data as prescribed by the Department in N.J.A.C. 11:24-7; and

4. A copy of the member mailing list as requested by the Department, in accordance with 11:24-7.3(f).

N.J. Admin. Code § 11:24-3.8

Recodified from N.J.A.C. 8:38-3.7 and amended by R.2000 d.183, effective 5/1/2000.
See: 31 N.J.R. 953(a), 32 N.J.R. 1544(a).