§ 8-43-604 — Performance programs

(1) All performance programs shall
include, at a minimum:

(a) A quality of care component that is satisfied by using standard treatment
guidelines promulgated by the director pursuant to section 8-42-101 or evidence-based administrative, operational, or clinical performance measures that improve
care;

(b) A clear representation of the weight given to the quality of care
component in comparison with other factors, which weight shall be equal to or
greater than any other factor;

(c) If a performance program includes an employer satisfaction element, a
patient satisfaction element, which shall be weighted equal to or greater than the
employer satisfaction element;

(d) Statistical analyses that are objective, accurate, valid, reliable, and
verifiable;

(e) A period of assessment of data, pertinent to the performance program,
which shall be updated at appropriate intervals;

(f) If claims data are used, accurate claims data appropriately attributed to
the provider. When reasonably available, the insurer shall use aggregated data
from other insurers to supplement its own claims data.

(g) The provider's responsibility for health-care decisions and the financial
consequences of those decisions, which shall be fairly and accurately attributed to
the provider.

(2) Performance program results shall be reported to each provider reviewed
in the program and shall include comparison of the provider's results to the results
of the provider's peers.

(3) Any disclosure to patients, other providers, employers, or the public of
the results of a performance program shall be accompanied by a conspicuous
disclaimer written in bold-faced type stating that the information is intended only
as a guide, should not be the sole factor in selecting a provider, has a risk of error,
and should be discussed with the provider.

Legislative History

Source: L. 2010: Entire part added, (SB 10-178), ch. 290, p. 1348, � 1, effective July 1.