Quality assurance program: Requirements; written description; informing providers; necessary staff; review; responsibility for activities.
1. Each managed care organization shall establish a quality assurance program designed to direct, evaluate and monitor the effectiveness of health care services provided to its insureds. The program must include, without limitation:
(a) A method for analyzing the outcomes of health care services;
(b) Peer review;
(c) A system to collect and maintain information related to the health care services provided to insureds;
(d) Recommendations for remedial action; and
(e) Written guidelines that set forth the procedures for remedial action when problems related to quality of care are identified.
2. Each managed care organization shall:
(a) Maintain a written description of the quality assurance program established pursuant to subsection 1, including, without limitation, the specific actions used by the managed care organization to promote adequate quality of health care services provided to insureds and the persons responsible for such actions;
(b) Provide information to each provider of health care whom it employs or with whom it contracts to provide health care services to insureds regarding the manner in which the quality assurance program functions;
(c) Provide the necessary staff to implement the quality assurance program and to evaluate the effectiveness of the program; and
(d) At least one time each year, review the continuity and effectiveness of the quality assurance program, review any findings of the quality improvement committee established pursuant to NRS 695G.190 and take any reasonable actions to improve the program.
3. Each managed care organization is responsible for an activity conducted pursuant to its quality assurance program, regardless of whether the managed care organization or another entity performs the activity.
Last modified: February 27, 2006