<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 10.09.57.07" title_num="10" subtitle_num="09" chapter_num="57" heading="Quality Assurance.">
  <text>A PCP shall maintain an internal quality assurance system based on written policies, standards, and procedures that is in accordance with accepted medical practices and professional standards and that includes, at a minimum, the following:</text>
  <paragraph num="A.">
    <text>A comprehensive quality assurance plan which:</text>
    <paragraph num="(1)">
      <text>Addresses both the quality of clinical care and nonclinical aspects of service such as accessibility, coordination, and continuity of care,</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provides for review by physicians and other health professionals of the process followed in the provision of health services,</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Provides feedback to health professionals and PCP staff regarding performance and patient results,</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Objectively and systematically monitors and evaluates the quality and appropriateness of care to enrollees through quality of care studies and related activities, and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Provides for continuous performance of the activities, including tracking of issues over time;</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A comprehensive utilization management program monitored by the PCP's governing body; and</text>
  </paragraph>
  <paragraph num="C.">
    <text>A credentialing process for determining whether physicians and other health professionals who are under contract to the PCP are licensed and qualified to perform their services.</text>
  </paragraph>
</regulation>