N.M. Admin. Code § 13.10.6.16

Current through Register Vol. 35, No. 24, December 23, 2024

Section 13.10.6.16 - QUALITY ASSURANCE

A. The prepaid dental plan shall provide an effective method for a continuing review and evaluation of the dental care provided to ensure that treatment and level of care were appropriate and adequate, that the quality of dental care provided met with acceptable standards, and that corrective action occurred or will occur if indicated.

B. There shall be a quality assurance committee appointed by the prepaid dental plan consisting of the chief executive officer or his designee, the dental director, practitioners of the dental healing arts, allied health professionals, and consumers who shall be members of the plan. Services performed by practitioners of the dental healing arts shall be reviewed and evaluated by members of this committee and evaluated by colleagues within their disciplines. The committee shall adopt administrative procedures covering frequency of meetings, types of records to be kept, and arrangements for committee reports and their dissemination.

C. The plan shall submit for approval of the director of the health services division a quality assurance plan which shall include procedures to be used for each of the following:

(1) establishment of standards for dental care at equivalent to those utilized by the professional standards review organization for medicare and medicaid reimbursement;

(2) surveillance of care provided;

(3) analysis of problems identified;

(4) correction of deficiencies including a time schedule for correction of the deficiencies;

(5) follow-up (periodic reassessment of the plan).

N.M. Admin. Code § 13.10.6.16

11/20/79; Recompiled 11/30/01