11 NCAC 20 .0504             ACTIVITIES

(a)  Each HMO shall develop quality of care and quality of service standards and establish a mechanism to determine if the standards are being met.

(b)  Each HMO shall employ a variety of quality management tools that assess and monitor:

(1)           The quality of health care and quality of service and that takes into account treatment settings for all types of medical care that have been provided through its network of providers; and

(2)           Administrative and utilization management decisions of the carrier.

History Note:        Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-140; 58-67-150;

Eff. October 1, 1996;

Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.