HARRY HUGHES, Governor

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EXAMINATIONS FOR EACH MEMBER WITHIN A REASONABLE TIME OF
ENROLLMENT SET BY IT.

(2)  MEDICAL PROBLEMS THAT ARE A POTENTIAL HAZARD TO
THE PERSON'S HEALTH SHALL BE IDENTIFIED AND A COURSE OF ACTION TO
ALLEVIATE THESE PROBLEMS OUTLINED.

(3)  PROGRESS NOTES INDICATING SUCCESS OR FAILURE OF
THE COURSE OF ACTION SHALL BE RECORDED.

(4)  THE HEALTH MAINTENANCE ORGANIZATION SHALL:

(I)  OFFER OR ARRANGE FOR PREVENTIVE SERVICES
THAT INCLUDE HEALTH EDUCATION AND COUNSELING, EARLY DISEASE
DETECTION, AND IMMUNIZATION;

(II)  DEVELOP OR ARRANGE FOR PERIODIC HEALTH
EDUCATION ON SUBJECTS WHICH IMPACT ON THE HEALTH STATUS OF A
MEMBER POPULATION; AND

(III)  NOTIFY EVERY MEMBER IN WRITING OF THE
AVAILABILITY OF THESE AND OTHER PREVENTIVE SERVICES.

(5)  THE HEALTH MAINTENANCE ORGANIZATION SHALL OFFER
SERVICES TO PREVENT A DISEASE IF:

(I)  THE DISEASE PRODUCES DEATH OR DISABILITY
AND EXISTS IN THE MEMBER POPULATION;

(II)  THE ETIOLOGY OF THE DISEASE IS KNOWN OR
THE DISEASE CAN BE DETECTED AT AN EARLY STAGE; AND

(III)  ANY ELIMINATION OF FACTORS LEADING TO THE
DISEASE OR IMMUNIZATION HAS BEEN PROVEN TO PREVENT ITS
OCCURRENCE, OR EARLY DISEASE DETECTION FOLLOWED BY BEHAVIOR
MODIFICATION, ENVIRONMENTAL MODIFICATION, OR MEDICAL INTERVENTION
HAS BEEN PROVEN TO PREVENT DEATH OR DISABILITY.

(D) (1) TO IMPLEMENT THESE STANDARDS OF QUALITY OF CARE, A
HEALTH MAINTENANCE ORGANIZATION SHALL HAVE A WRITTEN PLAN THAT IS
UPDATED AND REVIEWED AT LEAST EVERY 3 YEARS.

(2) THE PLAN SHALL INCLUDE THE FOLLOWING INFORMATION:

(I)  STATISTICS ON AGE, SEX, AND OTHER GENERAL
DEMOGRAPHIC DATA USED TO DETERMINE THE HEALTH CARE NEEDS OF ITS
POPULATION;

(II)  IDENTIFICATION OF THE MAJOR HEALTH
PROBLEMS IN THE MEMBER POPULATION;

(III)  IDENTIFICATION OF ANY SPECIAL GROUPS OF
MEMBERS THAT HAVE UNIQUE HEALTH PROBLEMS, SUCH AS THE POOR, THE
ELDERLY, THE MENTALLY ILL, AND EDUCATIONALLY DISADVANTAGED; AND