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 services 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 a quality improvement committee that shall include practicing physicians, individual 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;
   4. (4) meet no less than annually to receive and review reports of the quality improvement committee or group of committees and take action when appropriate; and
   5. (5) review the annual written report on the quality improvement program.

3. (c) The quality improvement committee shall develop and evaluate the overall effectiveness of the quality improvement program.

   1. (1) The quality improvement committee may delegate quality improvement activities to other committees that may, if applicable, include practicing physicians, individual providers, and enrollees from throughout the service area.

      1. (A) All committees shall collaborate and coordinate efforts to improve the quality, availability, and accessibility of health care services to be furnished by the HMO to its enrollees.
      2. (B) All committees shall meet and regularly report findings, recommendations, and resolutions in writing through the qualify improvement committee for the HMO governing body.
      3. (C) If the quality improvement committee delegates any quality improvement activity to any subcommittee, then the quality improvement committee must establish a method of oversight of each subcommittee.
   2. (2) The quality improvement committee shall use multidisciplinary teams, when indicated, to accomplish quality improvement program goals.

Source Note:The provisions of this §11.1901 adopted to be effective December 8, 1997, 22 TexReg 11684; amended to be effective July 31, 2002, 27 TexReg 6701.