Section R20-6-1811. Quality Improvement

A.      An Organization shall have a governing authority.

B.       The governing authority shall appoint a quality improvement committee that consists of the chief executive officer or desig- nee, the dental director, the person who manages the Organiza- tion’s quality improvement process, and at least one dental health professional. The committee may also include network allied health professionals and members of the plan.

C.      The quality improvement committee shall:

1.        Meet at least quarterly,

2.        Review and evaluate dental services delivered under the Organization’s plan, and

3.        Establish procedures for recordkeeping and distribution of committee reports.

D.      An Organization shall provide the director with a copy of the minutes of each quality improvement committee meeting within 30 days of the quality improvement committee meet- ing.

E.       An Organization shall maintain a written quality improvement plan that contains procedures for each of the following:

1.        Ensuring that a dentist licensed in any state or territory of the United States or District of Columbia reviews and

evaluates dental care and services provided by each con- tracted general dentist at least once every three years;

2.        Allocation of the Organization’s resources to analyze a problem or any identified deficiency;

3.        Implementing a corrective action plan and methods for monitoring improvement;

4.        Notifying a member in writing of the member’s responsi- bility to cooperate with those providing dental care ser- vices and of the member’s rights to:

a.         Voice concerns about the Organization or care pro- vided;

b.        Be provided with information about the Organiza- tion, its services, providers, and member rights and responsibilities;

c.         Participate in decisions about the member’s dental care; and

d.        Be treated with respect and have the right to privacy recognized;

5.        Monitoring and improving membership satisfaction;

6.        Maintaining an accurate provider directory that meets at least the following requirements:

a.         Lists only credentialed providers who are currently scheduling members for diagnosis and treatment; and

b.        Clearly designates providers who are not accepting new members;

7.        Review by the dental director of the following for initial credentialing of network providers:

a.         Query to the National Practitioner Data Bank;

b.        Query to BODEX;

c.         Valid United States Drug Enforcement Administra- tion certificate, if applicable;

d.        Evidence of current malpractice insurance; and

e.         Documentation that each specialist has graduated from an accredited specialty graduate program as required by BODEX.

8.        Recredentialing, at least every three years, that updates information obtained in subsections (E)(7)(b)  through (d), for the dental director’s review.

Historical Note

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