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Rule Chapter: 37.108
Chapter Title: MANAGED CARE QUALITY ASSURANCE
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37.108 : MANAGED CARE QUALITY ASSURANCE


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Rule No. Rule Title Latest
Version
Effective
Date
Subchapter 1
reserved
Subchapter 2
Network Adequacy for Managed Care
37.108.201 DEFINITIONS access file 9/24/1999
Rules 37.108.202 through 37.108.204 reserved
37.108.205 ACCESS PLAN FILING AND REVIEW GUIDELINES access file 9/24/1999
37.108.206 ACCESS PLAN UPDATES access file 9/24/1999
37.108.207 ACCESS PLAN SPECIFICATIONS access file 9/24/1999
37.108.208 ACCESS CRITERIA access file 9/24/1999
Rules 37.108.209 through 37.108.213 reserved
37.108.214 MANDATORY COVERAGE access file 9/24/1999
37.108.215 PROVIDER-ENROLLEE RATIO REQUIREMENTS access file 9/24/1999
37.108.216 VERIFICATION OF PROVIDER CREDENTIALS access file 9/24/1999
Rules 37.108.217 and 37.108.218 reserved
37.108.219 GEOGRAPHIC ACCESS CRITERIA access file 7/15/2005
37.108.220 EXCEPTIONS TO GEOGRAPHIC ACCESS CRITERIA access file 9/24/1999
37.108.221 SERVICE AREAS access file 9/24/1999
Rules 37.108.222 through 37.108.226 reserved
37.108.227 MAXIMUM WAIT TIMES FOR APPOINTMENTS access file 9/24/1999
37.108.228 REFERRAL AND SPECIALTY CARE REQUIREMENTS access file 9/24/1999
37.108.229 CONTINUITY OF CARE AND TRANSITIONAL CARE access file 9/8/2000
Rules 37.108.230 through 37.108.234 reserved
37.108.235 SELECTING AND CHANGING PROVIDERS access file 9/24/1999
37.108.236 REMOVAL OF BARRIERS TO ACCESS access file 9/24/1999
Rules 37.108.237 through 37.108.239 reserved
37.108.240 MONITORING THE NETWORK access file 9/24/1999
37.108.241 LETTERS OF INTENT access file 9/24/1999
37.108.242 RESPONSIBILITY FOR CONTRACTED SERVICES access file 9/24/1999
Rules 37.108.243 through 37.108.249 reserved
37.108.250 CORRECTIVE ACTION access file 9/24/1999
37.108.251 APPEAL FROM DEPARTMENT DECISION access file 9/24/1999
Subchapter 3
Independent Review of Health Care Decisions
37.108.301 INDEPENDENT REVIEW OF HEALTH CARE DECISIONS: DEFINITIONS access file 8/1/2003
Rules 37.108.302 through 37.108.304 reserved
37.108.305 INDEPENDENT REVIEW OF HEALTH CARE DECISIONS: PEER REVIEW PROCESS access file 8/1/2003
37.108.306 INDEPENDENT REVIEW OF HEALTH CARE DECISIONS: CONFIDENTIALITY access file 12/17/1999
Rules 37.108.307 through 37.108.309 reserved
37.108.310 INDEPENDENT REVIEW OF HEALTH CARE DECISIONS: NOTICE OF ADVERSE DETERMINATION AND INDEPENDENT REVIEW RIGHTS access file 8/1/2003
Rules 37.108.311 through 37.108.314 reserved
37.108.315 INDEPENDENT REVIEW OF HEALTH CARE DECISIONS: INTERNAL APPEALS PROCESS access file 8/1/2003
Subchapter 5
Quality Assurance for Managed Care Plans
37.108.501 PURPOSE access file 7/20/2001
37.108.502 DEFINITIONS access file 7/20/2001
Rules 37.108.503 and 37.108.504 reserved
37.108.505 QUALITY ASSURANCE STRUCTURE AND ACCREDITATION access file 7/20/2001
37.108.506 WRITTEN DESCRIPTION OF QUALITY ASSESSMENT PLAN access file 7/20/2001
37.108.507 COMPONENTS OF QUALITY ASSESSMENT ACTIVITIES access file 5/13/2017
Rules 37.108.508 and 37.108.509 reserved
37.108.510 QUALITY IMPROVEMENT access file 7/20/2001
37.108.511 CLINICAL FOCUSED STUDY access file 7/20/2001
Rules 37.108.512 through 37.108.514 reserved
37.108.515 ENROLLEE COMPLAINT SYSTEM access file 7/20/2001
37.108.516 RECORDING CONSUMER SATISFACTION access file 7/20/2001
Rules 37.108.517 through 37.108.519 reserved
37.108.520 CORRECTIVE ACTION access file 7/20/2001
37.108.521 INFORMAL RECONSIDERATION OF DEPARTMENT DECISION access file 7/20/2001
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