Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.57 - Partially Capitated Programs
Section 10.09.57.07 - Quality Assurance
Universal Citation: MD Code Reg 10.09.57.07
Current through Register Vol. 51, No. 19, September 20, 2024
A PCP shall maintain an internal quality assurance system based on written policies, standards, and procedures that is in accordance with accepted medical practices and professional standards and that includes, at a minimum, the following:
A. A comprehensive quality assurance plan which:
(1) Addresses both the quality of clinical
care and nonclinical aspects of service such as accessibility, coordination,
and continuity of care,
(2)
Provides for review by physicians and other health professionals of the process
followed in the provision of health services,
(3) Provides feedback to health professionals
and PCP staff regarding performance and patient results,
(4) Objectively and systematically monitors
and evaluates the quality and appropriateness of care to enrollees through
quality of care studies and related activities, and
(5) Provides for continuous performance of
the activities, including tracking of issues over time;
B. A comprehensive utilization management program monitored by the PCP's governing body; and
C. A credentialing process for determining whether physicians and other health professionals who are under contract to the PCP are licensed and qualified to perform their services.
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