NAC695C.410. Quality assurance committee: Appointment of members; staff; duties.

     1. The program established pursuant to NAC 695C.400 must include a quality assurance committee which is directed by either a licensed physician or dentist, as appropriate. The organization shall establish written guidelines for the manner in which members are appointed. The organization shall appoint members pursuant to those guidelines and provide adequate staff to assist the committee.

     2. The members of the committee must be selected from the health care providers with whom the organization has contracted to provide services to members. The members must include primary care physicians, physicians who provide commonly used specialized care and may include other persons who provide ancillary health care services.

     3. The committee shall:

     (a) Routinely select and review appropriate medical records of members and other data related to the quality of health care provided by health care providers.

     (b) Review the clinical processes used by providers of health care in providing services.

     (c) Identify any problems related to the quality of health care.

     (d) Advise health care providers regarding issues related to quality of care, performance of services, outcomes of services and provide recommendations for improving the quality of care when necessary.

     (e) Develop a methodology for monitoring and evaluating the quality of health care provided to members. The methodology must include an analysis of the quality of care provided for high volume common medical problems and less common higher risk medical problems.

     (f) Evaluate the impact on the quality of care caused by incentives offered to providers of health care by the organization to provide or not to provide certain services.

     (g) Interpret data collected pursuant to NAC 695C.420 for use by the organization.

     (Added to NAC by Bd. of Health, eff. 11-1-95)