10.07.11.08

.08 Policy Formulation.

A. The HMO shall have written policies governing the provision of the HMO services according to stated objectives of the HMO. The policies shall be developed in consultation with the executive officer, representative professionals, including one or more physicians, nursing service personnel associated with the service, and one or more enrollee representative or representatives. Policies shall be approved by the governing authority and reviewed and revised annually as required. These approvals shall be affirmed in writing and dated by an authorized representative of the governing authority.

B. Patient Care Policies. The policies shall cover at least the following:

(1) Inpatient admission and discharge policies;

(2) Physician (Independent Practice Association) services, including medical staff organization;

(3) Provision of or arrangements for other services not directly provided by the HMO;

(4) Continuity and availability of care through an established referral mechanism and ongoing contract with other health services providers.