Compilation of Rules and Regulations of the State of Georgia
Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER
Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE
Subject 120-2-80 - PATIENT PROTECTION ACT
Rule 120-2-80-.08 - Quality Assurance
Universal Citation: GA Rules and Regs r 120-2-80-.08
Current through Rules and Regulations filed through September 23, 2024
(1) A managed care entity shall disclose the quality assurance program in effect with documentation specified in Form GID PPA-1.
(2) The managed care entity must demonstrate, to the satisfaction of the Commissioner, that its quality assurance program includes organizational arrangements and ongoing procedures for the identification, evaluation, resolution and follow up of potential and actual problems in health care administration and delivery to enrollees. The program should include, but not be limited to procedures to:
(a) monitor and resolve complaints;
(b) monitor provider performance;
(c) monitor patient satisfaction;
(d) establish appropriate quality indicators based on current standards of the relevant health care profession;
(e) meet reasonable thresholds with regard to quality indicators;
(f) credential network providers according to established standards;
(g) ensure access to network providers by maintaining sufficient numbers of primary care physicians and other types of providers within the managed care entity's service area; and
(h) detect both under utilization and over utilization of services.
O.C.G.A. Secs. 33-2-9, 33-20A-2, 33-20A-4, 33-20A-5.
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