North Carolina Administrative Code
Title 11 - INSURANCE
Chapter 20 - MANAGED CARE HEALTH BENEFIT PLANS
Section .0500 - HMO QUALITY MANAGEMENT PROGRAMS
Section 20 .0505 - QUALITY OF CARE COMPLAINTS
Current through Register Vol. 39, No. 6, September 16, 2024
Each HMO shall maintain policies and procedures to record, investigate, and take corrective action in response to patient complaints about the quality of care delivered by network providers and decisions made by the HMO. The policies and procedures shall provide for the following:
(1) Complaints about quality of care issues shall be forwarded to and investigated by individuals who are capable of performing that function.
(2) A method of aggregating, categorizing, and analyzing quality of care complaints relating to provider performance or HMO policies or procedures.
Authority
G.S.
58-2-40(1);
58-67-5;
58-67-10;
58-67-20;
58-67-35;
58-67-65;
58-67-100;
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.
