Requirements for insurers offering managed health insurance
- • quality assessment
- • rules
All insurers offering managed health insurance in this state shall:
(1) Have a quality assessment program that enables the insurer to evaluate, maintain and improve the quality of health services provided to enrollees. The program shall include data gathering that allows the plan to measure progress on specific quality improvement goals chosen by the insurer.
(2) File an annual summary with the Department of Consumer and Business Services that describes quality assessment activities, including any activities related to credentialing of providers, and reports any progress on the insurer’s quality improvement goals.
(3) File annually with the department the following information:
(a) Results of all publicly available federal Centers for Medicare and Medicaid Services reports and accreditation surveys by national accreditation organizations.
(b) The insurer’s health promotion and disease prevention activities, if any, including a summary of screening and preventive health care activities covered by the insurer. In addition to the summary required in this paragraph, the consortium established pursuant to ORS 743.831 (Consortium established) shall develop recommendations for, and the department shall adopt rules requiring, reporting of an insurer’s health promotion and disease prevention activities related to:
(A) Two specific preventive measures;
(B) One specific chronic condition; and
(C) One specific acute condition. [1997 c.343 §5; 2003 c.14 §450]
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent. Currency Information