(a) Each prepaid limited health service organization shall have in writing a quality assurance program approved by the commissioner which describes the program's objectives, organization and problem solving activities.(b) The scope of the quality assurance program shall include, at a minimum:(1) Organizational arrangements and responsibilities for quality management and improvement processes;(2) A documented utilization management program;(3) Written policies and procedures for credentialing and recredentialing physicians and other licensed providers who fall under the scope of authority of the prepaid limited health service organization;(4) A written policy that addresses enrollees' rights and responsibilities;(5) The adoption of practice guidelines for the use of preventive health services; and(6) Any other criteria considered necessary by the commissioner.(c) This section becomes effective on May 1, 1999.
West Virginia Legal Code