NAC695C.275. Quality and performance indicators to be included in report of health maintenance organization.

     1. On or before November 1 of each year, each health maintenance organization which receives a certificate of authority shall submit to the State Board of Health the quality and performance indicators selected by the Board for the immediately preceding calendar year. The Board will select the indicators from the reporting set data domains set forth in Technical Specifications, Healthcare Effectiveness Data and Information Set (HEDIS), volume 2, in the form most recently published by the National Committee for Quality Assurance (NCQA), unless the Board gives notice that the most recent revision is not suitable for this State pursuant to subsection 3. Volume 2 of HEDIS may be obtained from the National Committee for Quality Assurance, NCQA, Department 4038, Washington, D.C. 20042-4038, for the price of $320 plus $20 for shipping and handling or by ordering via telephone at [phone] or on the Internet at http://www.ncqa.org/publications/.

     2. Each health maintenance organization shall include in its annual report, filed with the Commissioner pursuant to NRS 695C.210, a copy of the most recent quality and performance indicators submitted to the State Board of Health pursuant to subsection 1.

     3. The State Board of Health shall review each revision of the reporting set data domains set forth in Technical Specifications, Healthcare Effectiveness Data and Information Set (HEDIS), volume 2, to ensure their suitability for this State. If the Board determines that a revision is not suitable for this State, it will hold a public hearing to review its determination and give notice of that hearing within 6 months after the date of the publication of the revision. If, after the hearing, the Board does not revise its determination, the Board will, within 30 days after the hearing, give notice that the revision is not suitable for this State. If the Board does not give such notice, the revision becomes part of the reporting set data domains adopted by reference pursuant to subsection 1.

     (Added to NAC by Bd. of Health, eff. 11-1-95; A by R058-99, 11-4-99; A by Comm’r of Insurance by R148-99, 1-27-2000; R248-03, 11-12-2004; R106-08, 9-18-2008)