Ala. Admin. Code r. 560-X-53-.13

Current through Register Vol. 43, No. 1, October 31, 2024

Section 560-X-53-.13 - Quality Assessment And Performance Improvement

(1) A written data-driven plan for the Quality Assessment and Performance Improvement Program must be developed, implemented, and maintained by a PO. The plan must include all services provided by the PO, identify areas for maintaining and improving delivery of services and care, identify development and implementation methods to maintain and improve the quality of care provided, and a plan of action to document and inform appropriate parties of assessment and performance results. Interdisciplinary Team members, PACE staff, and contractors are to be involved in the development and implementation of all activities in the program and made aware of the results of the activities. The plan must be reviewed annually by the governing body of the PO and revisions made as needed.

(2) The Quality Assessment and Performance Improvement Program must include measures that will be used to demonstrate improved performance in the areas described in 460.134. The outcome measures must be based on current clinical practice guidelines and professional practice standards that are applicable to the care of participants in the PACE program. The PO must ensure that all data used is accurate and complete.

(3) The minimum levels of performance for standardized quality measures established by CMS and AMA as specified in the PACE program agreement must be met or exceeded. Areas for improvement should be prioritized based on the severity of the problems identified. Issues that directly or potentially threaten the health and safety of a Participant should be corrected immediately.

(4) A Quality Assessment and Performance Improvement Coordinator must be appointed to oversee the establishment and implementation of the program. Duties of the Coordinator include communication with Participants and caregivers to encourage their participation in the program, including their input regarding their satisfaction with the program.

(5) One or more committees with community input must be established. The duties of the committee(s) include the evaluation of the program's outcome measures and to review the implementation and results of the improvement plan. The committee(s) is to also provide input regarding ethical decision making, including end-of-life issues and implementation of the Patient Self-Determination Act.

(6) External quality assessment and reporting requirements as specified by CMS or AMA in accordance with §460.202 must also be met.

Ala. Admin. Code r. 560-X-53-.13

New Rule: Filed November 10, 2011; effective December 15, 2011.

Author: Linda Lackey, Medicaid Administrator, LTC Project Development Unit

Statutory Authority: State Plan, Attachment 2.2-A, Attachment 3.1-A and Supplement 3; 4 2 CFR 460 Subpart H.