Section R20-6-1803. Chief Executive Officer

A.      The governing authority shall appoint a chief executive officer (CEO). The CEO shall have:

1.        The education and experience to manage the Organiza- tion, and

2.        Responsibility for the geographic area in Arizona that the Organization serves, including:

a.         Implementing the policies of the governing author- ity, and

b.     Maintaining adequate personnel to ensure compli-		plete its substantive review and notify the Organization of
ance with applicable Arizona statutes and rules.		approval or disapproval of the proposed change within 60 days
B.    The governing authority shall notify the Department within ten		of notification of administrative completeness.
days after the effective date of a change in the appointment of	B.	An Organization shall provide the following information about
the CEO.		the prepaid dental plan to the Department quarterly:
Historical Note		1.     The total number of members and the number of mem-
New Section made by final rulemaking at 8 A.A.R. 463,		bers assigned to each general dentist’s office;
effective January 10, 2002 (Supp. 02-1).		2.     A list of all contracted network general dentists and spe-
		cialists that notes those who have been added or deleted
R20-6-1804.   Dental Director		since the previous quarterly report;
A.   The governing authority or CEO shall appoint as the Organiza-		3.     Verification that each specialist added to the network
tion’s dental director a dentist licensed to practice dentistry in		since the last quarterly report has graduated from a spe-
any state or territory of the United States or the District of		cialty graduate program accredited by the American Den-
Columbia.		tal  Association;   Documentation  of  the  Organization’s
B.    The dental director shall perform at least the following func-		quality improvement activities, including the number of
tions for the Organization’s geographic area in Arizona:		providers who have been credentialed or re-credentialed
1.     Participate on the Organization’s quality improvement		since the last quarterly report,  the number of facility
committee required under R20-6-1811;		reviews, and the number of chart reviews;
2.     Oversee the Organization’s program and processes for:		4.     The average wait time measured in weeks for an appoint-
a.      Maintaining and improving clinical quality of care,		ment for each network dentistry office;
including continuity of care;		5.     A copy of the current provider directory; and
b.     Provider relations;		6.     A  complaint  log  with  a   summary  of  Organization
c.      Facility and dental record reviews; and		responses by complaint category.
d.     Provider credentialing and recredentialing;	C.	An Organization shall submit the following information to the
3.     Be  knowledgeable   about  and  participate  in  decisions		Department at least annually:
regarding the Organization’s operations;		1.     Member satisfaction survey results and supporting data;
4.     Comply with A.R.S. § 20-2510(B) and (C) when directly		2.     Results of a survey of network general dentistry offices
denying, on the basis of medical necessity, a health care		with supporting data confirming a recall system under
provider’s request for prior authorization; and		R20-6-1809(B)(2);
5.     Timely respond to matters within the Organization’s Ari-		3.     An electronic database that lists the name, address, and
zona geographic area that require personal onsite atten-		telephone number of each provider and whether the pro-
tion or ensure that a designee who meets the requirements		vider is accepting new members. The Organization shall
specified in subsection (D) timely responds to those mat-		submit the database for general dentists and specialists
ters.		separately. The Organization shall submit any changes to
C.   Matters that require personal onsite attention include:		this database to the Department quarterly; and
1.     Urgent patient care issues that require examination of		4.     A report that compiles all the copays listed in all the
dental records or X-rays;		schedules of benefits offered by the Organization, with
2.     Prompt personal discussion with a provider of urgent		comparisons of the copays to the usual, customary, and
concerns relating to credentialing, disciplinary problems,		reasonable fees, as determined by the Organization, for
access to care, or quality of care.		the procedures listed on the schedule of benefits.

D.      Any designee acting under subsection (B)(5) shall:

1.        Be a dentist licensed to practice dentistry in any state or territory of the United States or the District of Columbia;

2.        Have expedient access to the dental director, the CEO, and other organization management personnel as neces- sary to resolve any matter requiring personal onsite atten- tion; and

3.        Have the education, experience, and Organizational knowledge required to address the matter requiring per- sonal onsite attention.

E.       The Organization shall notify the Department in writing within ten days after the effective date of a change in the appointment of the dental director or any designee.

F.       The requirements for a designee under subsections (B)(5), (D), and (E) shall not apply to an Organization with fewer than 2,000 members in Arizona.

Historical Note

New Section made by final rulemaking at 8 A.A.R. 463, effective January 10, 2002 (Supp. 02-1).