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 120-2-92 - INDEPENDENT ACCREDITATION OF HEALTH MAINTENANCE ORGANIZATIONS
Rule 120-2-92-.02 - Qualifications for Approved Accreditation Organizations
Universal Citation: GA Rules and Regs r 120-2-92-.02
Current through Rules and Regulations filed through March 20, 2024
(1) An organization may become an approved accrediting organization for purposes of this regulation when it meets the following requirements:
(a)
The organization has been in existence for a minimum of 10 years. An
organization in existence for less than 10 years may petition the Commissioner
for a waiver of this requirement;
(b) The organization is not owned or operated
by a health maintenance organization and performs its accrediting functions
independently from the control of health maintenance organizations;
(c) The organization operates on a national
basis;
(d) The organization's board
of directors is comprised of diverse health care, business and consumer
interests, including but not limited to representatives of the medical
profession, hospital industry, consumers, and health maintenance
organizations;
(e) The organization
has a process for regularly reviewing its own accreditation standards for
health maintenance organizations;
(f) The organization has provisions to
perform regular on-site reviews of health maintenance organizations;
(g) The organization establishes standards
for performance and uses those standards to examine and measure the performance
of health maintenance organizations in the following areas:
1. Quality Assurance and
Improvement
2. Member
Satisfaction
3. Appeals
Processes
4. Clinical
Oversight
5. Provider
Credentialing
6. Utilization
Review
7. Delegation
Oversight
8. Confidentiality of
Member Information
9. Access to
Services.
(h) A copy of
the organization's standards for accreditation must be made available to the
Department of Insurance upon request. Revisions to such standards shall also be
communicated to the Department. Such standards may be reviewed by the
Department of Insurance on a triennial basis. The Department may request
additional standards to be included within any approved organization's
standards for accreditation.
(i) In
each accreditation review, the organization must utilize a physician
experienced in health maintenance organization quality assurance
management;
(j) Upon request, the
Department may review the accreditation review files for a licensed health
maintenance organization.
(2) An organization seeking approval as an accrediting organization shall submit evidence to the Commissioner of its compliance with the standards in subparagraph (1) of this section. Upon submission of such evidence, the Commissioner, in his or her discretion, may include the organization on the Approved Accrediting Organizations List.
O.C.G.A. Secs. 33-2-9, 33-21-3, 33-21-18.
Disclaimer: These regulations may not be the most recent version. Georgia may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
