Michigan Laws 500.3508 – Quality assessment program; quality improvement program
Current as of: 2024 | Check for updates
|
Other versions
Terms Used In Michigan Laws 500.3508
- Director: means , unless the context clearly implies a different meaning, the director of the department. See Michigan Laws 500.102
- Health maintenance organization: means a person that, among other things, does the following:
(i) Delivers health services that are medically necessary to enrollees under the terms of its health maintenance contract, directly or through contracts with affiliated providers, in exchange for a fixed prepaid sum or per capita prepayment, without regard to the frequency, extent, or kind of health services. See Michigan Laws 500.3501
(1) A health maintenance organization shall develop and maintain a quality assessment program that includes, at a minimum, systematic collection, analysis, and reporting of relevant data in accordance with statutory and regulatory requirements.
(2) A health maintenance organization shall establish and maintain a quality improvement program to design, measure, assess, and improve the processes and outcomes of health care as identified in the program. A health maintenance organization shall place the quality improvement program under the direction of its medical director and include all of the following in the program:
(a) A written statement of the program’s objectives, lines of authority and accountability, evaluation tools, including data collection responsibilities, and performance improvement activities.
(b) An annual effectiveness review of the program.
(c) A written quality improvement plan that, at a minimum, describes how the health maintenance organization analyzes both the processes and outcomes of care, identifies the targeted diagnoses and treatments to be reviewed each year, uses a range of appropriate methods to analyze quality, compares program findings with past performance and internal goals and external standards, measures the performance of affiliated providers, and conducts peer review activities.