Skip to Content

Quality assurance standards - 28 Pa. Code § 9.674

Link to the law
This will open in a new window

A managed care plan must have an ongoing quality assurance program that includes review, analysis and assessment of the access, availability and provision of health care services; the plan must meet the following standards for its program:1

  •         Document all quality assurance activities and quality improvement accomplishments;
  •         Ensure that all participating health care providers maintain current and comprehensive medical records which conform to standard medical practice;
  •         Include consideration of clinical aspects of care, access, availability and continuity of care in the review of quality;
  •         Provide mechanisms for the sharing of results with health care providers in an educational format to solicit input and promote continuous improvement;
  •         Annually present to its board of directors a report of the plan’s activities documenting studies undertaken, evaluation of results, subsequent actions recommended and implemented, and aggregate data; and
  •         Include regularly updated standards for the following:

o       Health promotion;

o       Early detection and prevention of disease;

o       Injury prevention for all ages;

o       Systems to identify special chronic and acute care needs as early as possible; and

o       Access to routine, urgent and emergent appointments.


  • 1. 28 Pa. Code Chapter 9, Subchapter H, “Quality assurance standards” 28 Pa. Code § 9.674

Current as of June 2015