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007.05.1-XV. STATISTICAL INFORMATION.

AR ADC 007.05.1-XVArkansas Administrative Code

West's Arkansas Administrative Code
Title 007. Department of Health
Division 05. Health Facility Services
Rule 1. Rules and Regulations for Health Maintenance Organizations in Arkansas
Ark. Admin. Code 007.05.1-XV
007.05.1-XV. STATISTICAL INFORMATION.
Currentness
There shall be a procedure for the HMO to compile, develop, evaluate, and report, as may be requested and in the form indicated by the Director, statistics relating to the cost of operation, the pattern of utilization of services, and the availability and accessibility of services. Sufficient information shall be maintained to support continuity and adequate quality of care to Enrollees.
A. Each membership file shall include, as a minimum:
1. Name of the individual and if other than the individual, also the name and address of the Enrollee;
2. Individual's identification number;
3. Date of birth;
4. Sex;
5. Effective date;
6. Termination date and reason(s);
7. Date of most recent verification of information; and
8. Such other information as the Commissioner and Director may require.
B. Service area demographic characteristics which include the age, sex, and the geographic residence of Enrollees, and the number of Enrollees terminated during each one year period shall be available to the Department;
C. The HMO shall compile the number of medical services encounters, the number of Inpatient Medical Care encounters, and the number of direct ambulatory encounters for Enrollees for each one year period. The information shall be available to the Department as may be requested, and in the form indicated by the Director.
1. Medical services shall mean those services provided for the prevention, diagnosis, treatment, and rehabilitation of physical illness by Health Professionals.
2. Direct ambulatory encounters shall mean face-to-face contacts between patients not confined to a health care institution and a Health Professional employed actively and directly by the HMO, or by contract, who exercises independent judgment in the care and provision of Health Care Services to the patient. The term “independent” is used to distinguish between Health Professionals who assume major responsibility for the care of individual Enrollees and all other personnel who assist in providing that care.
D. Enrollee surveys and comments, as well as other materials shall be made available to the Director;
E. Each HMO shall annually, on or before the first day of March, file a report, verified by at least two principal officers of the HMO, with the Commissioner, with a copy to the Director, covering the previous calendar year. It shall include a summary of the statistical information required. Interim reports may be required by the Director.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 007.05.1-XV, AR ADC 007.05.1-XV
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