§ 131E-294. Additional consumer protection and quality standards.
§ 131E‑294. Additional consumer protection and quality standards.
Unless otherwise preempted by federal law or mandated by the Medicareprogram, the Division shall apply to provider sponsored organizations the samestandards and requirements that the Department of Insurance applies to healthmaintenance organizations under Chapter 58 of the General Statutes with respectto the following consumer protection and quality matters:
(1) Quality management programs (11 NCAC 20.0500, et seq.);
(2) Utilization review procedures (G.S. 58‑67‑61 andG.S. 58‑67‑62);
(3) Unfair or deceptive trade practices (Article 63 of Chapter58 of the General Statutes);
(4) Antidiscrimination (G.S. 58‑3‑25(b) and (c), 58‑3‑120,58‑63‑15(7), and 58‑67‑75);
(5) Provider accessibility and availability (11 NCAC 20.0300, etseq.);
(6) Network provider credentialing (11 NCAC 20.0400, et seq.);and
(7) Data reporting requirements under G.S. 58‑67‑50(e).(1998‑227, s. 1.)