Section 1380.1 Of Article 6. Operation And Renewal Requirements And Procedures From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 6.
1380.1
. (a) The Legislature finds and declares as follows:
(1) Multiple medical quality audits of health care providers, as
many as 25 for some physician offices, increase costs for health care
providers and health plans, and thus ultimately increase costs for
the purchaser and the consumer, and result in the direction of
limited health care resources to administrative costs instead of to
patient care.
(2) Streamlining the multiple medical quality audits required by
health care service plans and insurers is vital to increasing the
resources directed to patient care.
(3) Few legislative proposals affecting health care services have
the potential of benefiting all of the affected parties, including
health plans, health care providers, purchasers, and consumers,
through a reduction in administrative costs but without negatively
affecting patient care.
(b) The Advisory Committee on Managed Care shall recommend to the
director standards for a uniform medical quality audit system, which
shall include a single periodic medical quality audit. The director
shall publish proposed regulations in that regard on or before
January 1, 2002.
(c) In developing those standards, the Advisory Committee on
Managed Care shall seek comment from a broad and balanced range of
interested parties.
(d) The recommendations shall include all of the following:
(1) Standards that will serve as the basis of the single periodic
medical quality audit necessary to meet the criteria of this section.
(2) Standards that will not be covered by the single periodic
medical quality audit and that may be audited directly by health care
service plans.
(3) A list of those private sector accreditation organizations, if
any, that have or can develop systems comparable to the recommended
system, and the capability and expertise to accredit, audit, or
credential providers.
(e) (1) The director may approve private sector accreditation
organizations as qualified organizations to perform the single
periodic medical quality audits.
(2) Audits shall be conducted at least annually.
(f) The single medical quality audit shall not prevent licensed
health care service plans from developing performance criteria or
conducting separate audits for governmental or regulatory purposes,
purchasers, or to address consumer complaints and grievances,
management changes, or plan initiatives to improve or monitor
quality.