West Virginia Code of State Rules
Agency 114 - Insurance Commission
Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER
Series 114-56 - Quality Assurance Standards For Prepaid Limited Health Service Organizations
Section 114-56-9 - Preventive Health Services
Universal Citation: 114 WV Code of State Rules 114-56-9
Current through Register Vol. XLI, No. 38, September 20, 2024
9.1. A prepaid limited health service organization shall adopt guidelines for the use of preventive health services which must be based on reasonable medical evidence and the full service population. The guidelines shall be developed or adopted with the participation of the PLHSO's providers and must include a mechanism for periodic updates.
a. The guidelines and all updates shall
be provided in writing to all providers and members.
b. Each guideline shall describe the prevention or
early detection interventions and the recommended frequency and conditions under
which the interventions are required. The prepaid limited health service
organization shall document the scientific basis or authority upon which it based
the preventive health guidelines.
c.
Providers from the prepaid limited health service organization who have appropriate
knowledge shall be involved in the adoption of the preventive health
guidelines.
d. At least annually, a
PLHSO shall monitor, evaluate and take action upon a minimum of two of the following
preventive services as appropriate:
1. Infancy,
childhood and pre-adolescent screening and educational interventions such as
learning and behavioral problems in preschoolers; child abuse and neglect; and
impulse disorders;
2. Adolescent
screening and educational interventions such as depression, acting out, and
oppositional disorders; eating disorders; alcohol and drug abuse; suicidal ideation;
and high-risk sexual behavior;
3. Adult
screening and educational interventions such as mood disorders; obsessive compulsive
disorders; anxiety disorders; schizophrenia; eating disorders; and alcohol and drug
abuse including prescription drug dependence;
4. Family and community educational interventions
such as healthy lifestyle choices; parent training; stress management; dying, loss
and bereavement; domestic violence; and community resources;
5. Elderly screening and educational interventions
such as mood disorders; organic brain syndrome; complications from chronic
illnesses; and substance dependence including prescription drug dependence;
and
6. Any other preventive services
deemed appropriate by the commissioner and any other state or federal regulatory
authorities.
e. Preventive
health service studies shall be enrollee population-based, measuring compliance as
it relates to the total at-risk population.
Disclaimer: These regulations may not be the most recent version. West Virginia 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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