Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 11 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter T - QUALITY OF CARE
Section 11.1901 - Quality Improvement Structure for Basic, Single Service, and Limited Service HMOs
Universal Citation: 28 TX Admin Code § 11.1901
Current through Reg. 50, No. 13; March 28, 2025
(a) Basic, single service, and limited service HMOs must develop and maintain an ongoing QI program designed to objectively and systematically monitor and evaluate the quality and appropriateness of care and services and to pursue opportunities for improvement. Unless the HMO has no enrollees, the QI program should include the active involvement of one or more enrollee(s) who are not employees of the HMO.
(b) The HMO governing body is ultimately responsible for the QI program. The governing body must:
(1) appoint a quality improvement committee
(QIC) that must include practicing physicians and individual providers, and may
include one or more enrollee(s) from throughout the HMO's service area, none of
whom may be employees of the HMO;
(2) approve the QI program;
(3) approve an annual QI plan;
(4) meet at least annually to receive and
review reports of the QIC or group of committees and take action when
appropriate; and
(5) review the
annual written report on the QI program.
(c) The QIC must evaluate the overall effectiveness of the QI program.
(1) The QIC
may delegate QI activities to other committees that may, if applicable, include
practicing physicians, individual providers, and enrollees from the service
area.
(A) All committees must collaborate and
coordinate efforts to improve the quality, availability, and accessibility of
health care services.
(B) All
committees must meet regularly and report the findings of each meeting,
including any recommendations, in writing to the QIC.
(C) If the QIC delegates any QI activity to
any subcommittee, then the QIC must establish a method to oversee each
subcommittee.
(2) The
QIC must use multidisciplinary teams, when indicated, to accomplish QI program
goals.
Disclaimer: These regulations may not be the most recent version. Texas 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.
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