| (a) An HCC must develop and maintain an ongoing quality
improvement (QI) program designed to objectively and systematically
monitor and evaluate the quality and appropriateness of health care
services that it arranges for or offers, and to pursue opportunities
for improvement. Unless the HCC has no patients, the QI program must
include the active involvement of one or more patient(s) who are not
employees of the HCC.
(b) The governing body is ultimately responsible for
the QI program. The governing body must:
(1) appoint a quality improvement committee (QIC) that
includes the clinical director, practicing physicians, and, if applicable,
other individual health care providers;
(2) approve the QI program;
(3) approve an annual QI plan;
(4) meet no less than semiannually to receive and review
reports of the QIC or group of committees and take action when appropriate;
and
(5) review the annual written report on the QI program.
(c) The QIC must evaluate the overall effectiveness
of the QI program.
(1) The QIC may delegate QI activities to other committees
that may, if applicable, include practicing physicians and individual
health care providers and patients from the service area.
(A) All committees must collaborate and coordinate
efforts to improve the quality, availability, and accessibility of
health care services.
(B) All committees must meet regularly and report the
findings of each meeting, including any recommendations, in writing
to the QIC.
(C) If the QIC delegates any QI activity to any subcommittee,
then the QIC must establish a method to oversee each subcommittee.
(2) The QIC must use multidisciplinary teams when indicated
to accomplish QI program goals. For example, an HCC could include
only a narrow range of specialty health care services, making the
use of multidisciplinary teams impractical.
|
