1. A. The HCSO shall provide an effective process for a continuing review and evaluation of the covered services it provides to enrollees to ensure that:

   1. 1. Treatment and level of covered services are appropriate and adequate and
   2. 2. The quality of covered services is acceptable to the HCSO.

2. B. The HCSO shall have a quality assurance committee that includes at least the CEO or designee, the medical director, and representative network providers. The quality assurance committee shall:

   1. 1. Arrange for physicians or practitioners to review and evaluate covered services provided by others physicians or practitioners within the respective disciplines.
   2. 2. Adopt administrative procedures covering frequency of meetings, recordkeeping, committee reports, and disseminating the reports.

3. C. The HCSO’s effective process in subsection (A) shall include the following:

   1. 1. Standards for health care;
   2. 2. Monitoring of care;
   3. 3. Analysis of any deficiency;
   4. 4. Correcting a deficiency including submitting a schedule for correcting the deficiency, requiring continuing education for the provider, if appropriate, and follow-up and periodic reassessment of the deficiency.

Historical Note

New Section made by exempt rulemaking at 7 A.A.R. 2769, effective July 1, 2001 (Supp. 01-2). Section R20-6-1908 renumbered to R20-6-1906; new Section R20-6-1908 renumbered and amended from R20-6-1911, by final rulemaking at 11 A.A.R. 4861, effective December 31, 2006 (Supp. 05-4).