Sec. 10.09.57.07. Quality Assurance

A PCP shall maintain an internal quality assurance system based on written policies, standards, and procedures that is in accordance with accepted medical practices and professional standards and that includes, at a minimum, the following:

A. A comprehensive quality assurance plan which:

(1) Addresses both the quality of clinical care and nonclinical aspects of service such as accessibility, coordination, and continuity of care,

(2) Provides for review by physicians and other health professionals of the process followed in the provision of health services,

(3) Provides feedback to health professionals and PCP staff regarding performance and patient results,

(4) Objectively and systematically monitors and evaluates the quality and appropriateness of care to enrollees through quality of care studies and related activities, and

(5) Provides for continuous performance of the activities, including tracking of issues over time;

B. A comprehensive utilization management program monitored by the PCP's governing body; and

C. A credentialing process for determining whether physicians and other health professionals who are under contract to the PCP are licensed and qualified to perform their services.