MANAGED CARE December 1998. ©1998 Stezzi Communications
New regulations taking effect in Colorado this month tighten reporting rules and seek to gain greater proof that health plans are delivering quality care.
The regulations require plans to have written quality assurance programs to evaluate their services. The plans must detail the treatments and conditions that will be reviewed, and conduct research to improve services and health outcomes. Plans must also demonstrate that they are providing adequate access to care and are also educating members about wellness and chronic-disease management.
Colorado's Cross-Disabilities Coalition criticized the new rules as inadequate, noting that HMOs will not be required to make their quality assurance plans available to the public, and that the rules do not address home-health care services.
Colorado's Department of Public Health and Environment developed the rules and will administer them jointly with the Division of Insurance and the Department of Health Care Policy and Financing, which regulates Medicaid in the state. The final version of the regulations is available at http://www.cdphe.state.co.us/ [1].