W. Va. Code R. § 114-56-3

Current through Register Vol. XLI, No. 45, November 8, 2024

Section 114-56-3 - Goals of a Quality Assurance Program

3.1. The goals of a prepaid limited health service organization's quality assurance program shall be to:

a. Assure the provision of appropriate limited health services delivered to members, while simultaneously addressing the effectiveness of quality of care;

b. Monitor, evaluate and improve the quality of care for limited health services;

c. Provide a systematic process that promotes the delivery of appropriate care in a timely, effective and efficient manner, while maintaining the quality of care for limited health services;

d. Direct members and providers toward the goal of quality and cost effective care for limited health services.

3.2. A prepaid limited health service organization's quality assurance program shall include a mechanism for identifying potential utilization management issues and linking them to the PLHSO's utilization management program.

W. Va. Code R. § 114-56-3