6.6.8911    CLINICAL FOCUSED STUDY

(1) The health carrier shall conduct a focused study relevant to the quality of its services for enrollee care. The health carrier must document the clinical focused study and submit it to the commissioner at the commissioner's request.

(2) The health carrier shall select topics for the focused study that are justified based on any of the following considerations:

(a) areas of high volume;

(b) areas of high risk;

(c) areas where problems are expected or where they have occurred in the past;

(d) areas that can be corrected or where prevention may have an impact;

(e) areas that have potential adverse health outcomes; and

(f) areas where enrollee complaints have occurred.

(3) The health carrier shall document the study methodology employed, including:

(a) the focused study question;

(b) the sample selection;

(c) data collection;

(d) evaluation criteria; and

(e) measurement techniques.

 

History: 33-36-105, MCA; IMP, 33-36-303, MCA; NEW, 2001 MAR p. 1342, Eff. 7/20/01; TRANS, from 37.108.511, 2023 MAR p. 1403, Eff. 1/1/24; AMD, 2024 MAR p. 714, Eff. 4/13/24.