Whenever any HMO delegates quality management activities to another entity, the HMO shall review and approve the entity's quality management program before contracting with the entity and shall monitor the entity's quality management activities. The HMO shall implement oversight mechanisms, including:

1. (1) Reviewing the contracting entity's quality management plans, policies, procedures, activities, and provider contracting forms; and verifying that they meet the HMO's standards.
2. (2) Requiring the contracting entity to submit, at least annually, reports of its quality management activities and operations.
3. (3) Conducting audits of the contracting entity's quality assurance activities and operations.

History Note: Authority G.S. 58-2-40(1); 58-67-5; 58-67-10; 58-67-20; 58-67-35; 58-67-65; 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.