Section 13-5 - Organization (a) The HMO will be organized in a manner which allows attainment of its stated mission which as a minimum, shall be to provide and/or to cause to be provided: - (ii) Inpatient hospital and medical-surgical care; and
- (iii) Outpatient services.
(b) A governing body, person, or persons legally responsible for the operation of the HMO shall provide for the following: - (i) A copy of the agreement, contract, or policy which the HMO proposes to issue to subscribers which describes the scope of the health care services it renders as permitted by law to enrollees either directly by a medical staff or through arrangements with others;
- (ii) The names of all physicians and providers giving their license number, if required by the Department of Health and Social Services, Division of Health and Medical Services, business address, specialty where applicable, certification of eligibility, and medical or hospital staff privileges of hospitals used or by which the HMO has a contractual agreement;
- (iii) The maintenance of a list of the above information;
- (iv) The appointment of a chief executive officer either full-time or part-time in accordance with the demands of that office;
- (v) The appointment of a medical director either full-time or part-time in accordance with the demands of that office. The medical direction may serve as the chief of the medical staff Medical staff bylaws, rules, or regulations, are required to include provisions for the delivery of health services by physicians and professional health care providers, licensed or duly authorized to practice in the State of Wyoming. Other providers, as required, to support the medical staff must be available in order to assure that the enrollee receives health care services with continuity and without unreasonable periods of delay; and
- (vi) An ongoing procedure and program to monitor effectively the quality of the health care requirements set forth herein. The treatment outcome shall include, but is not limited to, a procedure for peer review.
044-13 Wyo. Code R. § 13-5