North Carolina Administrative Code
Title 11 - INSURANCE
Chapter 20 - MANAGED CARE HEALTH BENEFIT PLANS
Section .0500 - HMO QUALITY MANAGEMENT PROGRAMS
Section 20 .0504 - ACTIVITIES
Universal Citation: 11 NC Admin Code 20 .0504
Current through Register Vol. 39, No. 6, September 16, 2024
(a) Each HMO shall develop quality of care and quality of service standards and establish a mechanism to determine if the standards are being met.
(b) Each HMO shall employ a variety of quality management tools that assess and monitor:
(1) The quality of health care and quality of
service and that takes into account treatment settings for all types of medical
care that have been provided through its network of providers; and
(2) Administrative and utilization management
decisions of the carrier.
Authority
G.S.
58-2-40(1);
58-67-5;
58-67-10;
58-67-20;
58-67-35;
58-67-65;
58-67-140;
58-67-150;
Eff.
October 1, 1996;
Pursuant to
G.S.
150B-21.3A, rule is necessary without
substantive public interest Eff. December 16,
2014.
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