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007.05.1-XXI. ONSITE QUALITY OF CARE REVIEWS.

AR ADC 007.05.1-XXIArkansas 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-XXI
007.05.1-XXI. ONSITE QUALITY OF CARE REVIEWS.
Currentness
A. The Director shall conduct an examination concerning the quality and appropriateness of covered Health Care Services provided and/or arranged for by the HMO as often as is deemed necessary for the protection of the interests of the citizens of this State and for the protection of Enrollees of each HMO. The examination shall not be less frequent than once every three (3) years. Such examinations shall be subsequent to the issuance of a Certificate of Authority.
B. The examination shall be based on, but not limited to, the following:
1. The effectiveness of quality of care monitoring;
2. A medical referral system which is both available and accessible;
3. Continuing education programs to upgrade the expertise of all professional and non-professional personnel; and
4. Other quality issues in relation to the number of Enrollees.
C. Complaints concerning the quality of care shall be investigated by the Department without prior notice to the HMO. Complaints determined to be substantiated may require a full survey of the HMO, which shall be unannounced.
D. Requirements concerning a statement of deficiencies cited on surveys and complaint investigations are as follows:
1. The Department shall provide the HMO with a written statement of the survey outcome;
2. If deficiencies are cited, a written plan of correction shall be returned to the Department within thirty (30) days of receipt of the written statement of deficiencies;
3. Deficiencies which represent an immediate health and safety concern to Enrollees shall be corrected in a time frame that is appropriate. A time frame will be established for each such deficiency, and in no case shall exceed thirty (30) days from the date of receipt of the written statement of deficiencies;
4. All other deficiencies shall be corrected within sixty (60) days of receipt of the written statement of deficiencies. Documentation for justification of a longer time frame shall be provided to the Director.
E. The Department may impose disciplinary action in the following instances:
1. The HMO fails to develop an acceptable plan of correction for deficiencies within the time frame allowed;
2. The HMO fails to implement and complete its plan of correction within the time frame approved by the Department;
3. The HMO fails to notify the Department of changes in operation that would affect previous considerations for applications or amendments to the Certificate of Authority;
4. The HMO fails to provide the Department with required reports and other documents, as requested; and
5. The HMO fails to pay fees or other expenses required by these Rules and Regulations.
F. Each affected HMO shall receive written notice of the Department's disciplinary action. A written response shall be made to the Department within ten (10) calendar days of receipt of the notice. The response may exercise the HMO's right of appeal of the Director's disciplinary action.
G. Any charge of noncompliance shall be removed after determination that the HMO has corrected the deficiency(ies) which prompted the request for disciplinary action.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 007.05.1-XXI, AR ADC 007.05.1-XXI
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