As part of its overall quality evaluation activities, the health maintenance organization shall conduct focused studies to acquire information relevant to quality of care. The focused study must be directed at problems, potential problems, or areas with potential for improvements in care. The focused studies shall be included as part of the health maintenance organization's problem identification and selection activities.
The health maintenance organization shall select topics for focused study that must be justified based on any of the following considerations:
areas of high volume;
areas of high risk;
areas where problems are expected or where they have occurred in the past;
areas that can be corrected or where prevention may have an impact;
areas that have potential adverse health outcomes; and
areas where complaints have occurred.
The health maintenance organization shall document the study methodology employed, including:
the focused study question;
the sample selection;
Any corrective actions implemented to address problems identified through focused studies shall follow the requirements defined in part 4685.1120, subparts 3 and 4.
An activity in which the health maintenance organization participates that meets any of the criteria in subparts 2 to 4 may satisfy in part or in total the focused study requirements. Examples of other activities that may satisfy the focused study requirements include external audits conducted by the professional review organization or other review organizations, multiple health plan surveys, or quality assurance studies across the community.
14 SR 903
October 11, 2007
Official Publication of the State of Minnesota
Revisor of Statutes