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Vt. Stat. Ann. tit. § 18, 9414 - Quality assurance for managed care organizations under the health law
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Current as of June 2015
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“Quality assurance for managed care organizations under the health law”
The commissioner of financial regulation must review a managed care organization’s administrative policies and procedures, quality management and improvement procedures, utilization management, members’ rights and responsibilities, preventive health services, medical records practices, grievance and appeal procedures, etc. A managed care organization must disclose its policies and procedures in plain language to its members.
The managed care organization must have an internal, written quality assurance program to monitor and evaluate its health care services across all institutional and noninstitutional settings.
In addition to its internal quality assurance program, each managed care organization must evaluate the quality of health and medical care provided to members. The organization must use and maintain a patient record system which will facilitate documentation and retrieval of statistically meaningful clinical information. A managed care organization may evaluate the quality of health and medical care provided to members through an independent accreditation organization.
Related laws:
Vermont Administrative Code 21 040 010
Current as of June 2015
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