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Quality assurance standards - 28 Pa. Code § 9.674
Link to the law
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Current as of June 2015
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A managed care plan must have an ongoing quality assurance program that includes review, analysis and assessment of the access, availability and provision of health care services; the plan must meet the following standards for its program:1
- Document all quality assurance activities and quality improvement accomplishments;
- Ensure that all participating health care providers maintain current and comprehensive medical records which conform to standard medical practice;
- Include consideration of clinical aspects of care, access, availability and continuity of care in the review of quality;
- Provide mechanisms for the sharing of results with health care providers in an educational format to solicit input and promote continuous improvement;
- Annually present to its board of directors a report of the plan’s activities documenting studies undertaken, evaluation of results, subsequent actions recommended and implemented, and aggregate data; and
- Include regularly updated standards for the following:
o Health promotion;
o Early detection and prevention of disease;
o Injury prevention for all ages;
o Systems to identify special chronic and acute care needs as early as possible; and
o Access to routine, urgent and emergent appointments.
Footnotes
- 1. 28 Pa. Code Chapter 9, Subchapter H, “Quality assurance standards” 28 Pa. Code § 9.674
Current as of June 2015