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Mich. Admin. Code r. 325.6830 - Periodic examination of health care services; financial examinations

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The Department of Community Health may examine the quality of health care services being provided by an insurer or health plan.  In conducting such an examination, the Department must look at the following:

  1. Results of the quality assurance program and utilization review;
  2. Evaluation of the availability, accessibility and continuity of services;
  3. Inspection and evaluation of the clinical record system;
  4. Compliance with the Department’s rules;

The Department must also conduct a financial evaluation of the health plan.

Current as of June 2015