West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-53 - Quality Assurance
Section 114-53-3 - Goals of a Quality Assurance Program
Universal Citation: 114 WV Code of State Rules 114-53-3
Current through Register Vol. XLI, No. 38, September 20, 2024
3.1. The goals of a health maintenance organization's quality assurance program shall be to:
a. Assure the provision of appropriate medical
services delivered to members, while simultaneously addressing the effectiveness of
quality of care;
b. Monitor, evaluate
and improve the quality of health care;
c. Provide a systematic process that promotes the
delivery of medically appropriate care in a timely, effective and efficient manner,
while maintaining the quality of health care;
d. Direct members and providers toward the goal of
quality, cost effective health care.
3.2. A health maintenance organization's quality assurance program shall include a mechanism for identifying potential utilization management issues and linking them to the HMO's utilization management program.
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