Regulatory Compliance & Oversight

The QMetrics team has 15+ years working in the regulatory compliance space. Our Regulatory Compliance Division is led by our Chief Compliance Officer & Sr. VP Regulatory Affairs who holds a Juris Doctor from USD School of Law and served as director of Legislative & Regulatory Affairs and Chief Compliance Officer at a California DMHC licensed health plan for 10 years. Our team has served as the primary health plan liaison to numerous regulatory bodies including the California Department of Labor and CCIIO.

QMetrics can assist with interpreting and implementing both state and federal statutory, regulatory provisions, and sub-regulatory guidance. Additionally, we offer health plans guidance on oversight of delegated entities to ensure compliance with new and existing laws impacting health plan operations.

A snapshot of regulatory, compliance, and oversight services offered are:

  • Compliance assessment, development and training in areas such as:
    • California Knox-Keene Act, Title 28 CCR, and DMHC guidance
    • Covered California / Qualified Health Plan (QHP) requirements
    • Affordable Care Act, regulations, and sub-regulatory guidance
    • HIPAA, HITECH and California privacy requirements
    • 7 Elements of an Effective Compliance Program
  • Implementation plans for new laws
  • Regulatory filing assistance
  • Audit preparation and delegation oversight

Contact us at: info@qmetrics.us for a complimentary consultation.

Click here for a PDF version of this service description.