(1) All performance programs shall include, at a minimum:
A quality of care component that is satisfied by using standard treatment guidelinespromulgated by the director pursuant to section 8-42-101 or evidence-based administrative, operational, or clinical performance measures that improve care;
A clear representation of the weight given to the quality of care component in comparison with other factors, which weight shall be equal to or greater than any other factor;
If a performance program includes an employer satisfaction element, a patient satisfaction element, which shall be weighted equal to or greater than the employer satisfaction element;
Statistical analyses that are objective, accurate, valid, reliable, and verifiable;
A period of assessment of data, pertinent to the performance program, which shall beupdated at appropriate intervals;
If claims data are used, accurate claims data appropriately attributed to the provider.When reasonably available, the insurer shall use aggregated data from other insurers to supplement its own claims data.
The provider's responsibility for health care decisions and the financial consequencesof those decisions, which shall be fairly and accurately attributed to the provider.
Performance program results shall be reported to each provider reviewed in the program and shall include comparison of the provider's results to the results of the provider's peers.
Any disclosure to patients, other providers, employers, or the public of the results ofa performance program shall be accompanied by a conspicuous disclaimer written in bold-faced type stating that the information is intended only as a guide, should not be the sole factor in selecting a provider, has a risk of error, and should be discussed with the provider.
Source: L. 2010: Entire part added, (SB 10-178), ch. 290, p. 1348, § 1, effective July 1.