11 NCAC 20 .0505             QUALITY OF CARE COMPLAINTS

Each HMO shall maintain policies and procedures to record, investigate, and take corrective action in response to patient complaints about the quality of care delivered by network providers and decisions made by the HMO.  The policies and procedures shall provide for the following:

(1)           Complaints about quality of care issues shall be forwarded to and investigated by individuals who are capable of performing that function.

(2)           A method of aggregating, categorizing, and analyzing quality of care complaints relating to provider performance or HMO policies or procedures.

History Note:        Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 58-67-100; 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.