Minnesota Administrative Rules

4685.1130 FILED WRITTEN PLAN AND WORK PLAN.

Subpart 1.

Written plan.

The health maintenance organization shall file its written quality assurance plan, as described in part 4685.1110, subpart 1, with the commissioner, before being granted a certificate of authority.

Subp. 2.

Annual work plan.

The health maintenance organization shall annually prepare a written work plan. The health maintenance organization shall file the work plan with the commissioner, as requested. The work plan must be approved by the governing body and meet the requirements of items A and B.

A.

The work plan must give a detailed description of the proposed quality evaluation activities that will be conducted in the following year and a timetable for completion. The quality evaluation activities must address the components of the health care delivery system defined in part 4685.1115, subpart 2. The quality evaluation activities must be conducted according to the steps in part 4685.1120.

In determining the level of quality evaluation activities necessary to address each of the components of the health maintenance organization, the commissioner shall consider the number of enrollees, the number of providers, the age of the health maintenance organization, and the level of quality evaluation activities conducted by health care organizations that perform similar functions.

B.

The work plan must describe the proposed focused studies to be conducted in the following year. The focused studies must be conducted according to the steps in part 4685.1125. Each proposed study must include the following elements:

(1)

topic to be studied;

(2)

rationale for choosing topic for study according to part 4685.1125, subpart 1;

(3)

benefits expected to be gained by conducting the study;

(4)

study methodology;

(5)

sample size and sampling methodology;

(6)

criteria to be used for evaluation; and

(7)

approval by the health maintenance organization's medical director or qualified director of health services designated by the governing body.

Each health maintenance organization shall annually complete a minimum of three focused studies. The focused study sample must be representative of all health maintenance organization enrollees who exhibit characteristics of the issue being studied.

Subp. 3.

Amendments to plan.

The health maintenance organization may change its written quality assurance plan by filing notice with the commissioner 30 days before modifying its quality assurance program or activities. If the commissioner does not disapprove of the modifications within 30 days of submission, the modifications are considered approved.

Subp. 4.

Plan review.

Upon receipt of the filing, the commissioner shall review the health maintenance organization's annual proposed work plan to determine if it meets the criteria established in parts 4685.1105 to 4685.1130.

Subp. 5.

[Repealed, 23 SR 1238]

Statutory Authority:

MS s 62D.03; 62D.04; 62D.11; 62D.20

History:

14 SR 903; 23 SR 1238

Published Electronically:

October 11, 2007