ARM 6.6.8911

37.108.511 CLINICAL FOCUSED STUDY (1) The health carrier shall conduct a focused study relevant to the quality of its services for enrollee care. The health carrier must document the clinical focused study and submit it to the department by October 1 of each year. (2) The health carrier shall select topics for the focused study that are justified based on any of the following considerations: (a) areas of high volume; (b) areas of high risk; (c) areas where problems are expected or where they have occurred in the past; (d) areas that can be corrected or where prevention may have an impact; (e) areas that have potential adverse health outcomes; and (f) areas where enrollee complaints have occurred. (3) The health carrier shall document the study methodology employed, including: (a) the focused study question; (b) the sample selection; (c) data collection; (d) evaluation criteria; and (e) measurement techniques.