Okla. Admin. Code § 310:657-5-2

Current through Vol. 42, No. 8, January 2, 2025

Section 310:657-5-2 - Quality assessment and quality improvement

(a) The Plan, either directly or through contract, shall maintain a quality assessment and improvement system. The system shall have at least these features:

(1) Systematic collection and analysis of data, including measures of provider performance; and

(2) Activities to foster continuous improvement of services provided to injured workers, including:

(A) identifying practices which result in positive health outcomes; and

(B) integrating information sources such as service management, claims processing, worker satisfaction and grievances.

(3) Organizational support for the system with input from the medical director;

(4) Methods of evaluating performance improvement activities.

(b) The quality assessment and improvement system shall include the following functions, done at least annually:

(1) An analysis of care patterns in the following priority areas:

(A) Services likely to affect many injured workers;

(B) Procedures that could place the health of injured workers at risk;

(C) Variations in practice patterns; and

(D) Underuse and overuse of medical and health services;

(2) An evaluation of access to medical and health services.

Okla. Admin. Code § 310:657-5-2

Added at 12 Ok Reg 2977, eff 6-16-95 (emergency); Added at 13 Ok Reg 2127, eff 6-13-96