1. (a) The HMO shall develop and maintain an ongoing quality improvement program designed to objectively and systematically monitor and evaluate the quality and appropriateness of care and service provided to enrollees, and to pursue opportunities for improvement.

2. (b) The HMO governing body is ultimately responsible for the overall quality improvement program. The HMO governing body shall:

   1. (1) appoint the formal quality improvement committee which shall include practicing physicians, dentists, other providers and at least one enrollee from throughout the HMO's service area. For purposes of this section, the enrollee appointed to the committee may not be an employee of the HMO;
   2. (2) approve the quality improvement program;
   3. (3) approve an annual quality improvement plan; and
   4. (4) receive and review reports of the quality improvement committee or group of committees and take action when appropriate.

Source Note:The provisions of this §11.1901 adopted to be effective December 8, 1997, 22 TexReg 11684.