Sec.19-13-D89. Quality assurance program

(a) An agency shall have a written quality assurance program which shall include but not be limited to:

(1) Program evaluation:

(2) Patient record review.

(b) The governing authority, or a committee appointed by the governing authority and the patient care advisory committee shall conduct the program evaluation which shall include, but not be limited to:

(1) The extent to which the agency's objectives, policies and resources are adequate to maintain programs and services appropriate to community, patient and family needs;

(2) The extent to which the agency's administrative practices and patterns for delivery of services achieve efficient and effective community, patient and family services in a five (5) year cycle.

(c) At least quarterly, the professional members of the patient care advisory committee shall review a random sample of active and closed patient records. Each record review shall be documented on a record review form and shall include, but not be limited to verification, that:

(1) Agency policies are followed in the provision of services to patients and families;

(2) Homemaker-home health aide services are utilized appropriately in relation to agency resources and patient or family resources;

(3) Services are provided only to patients whose level of care needs can be safely met by a homemaker-home health aide;

(4) Provision of care is coordinated within the agency and with other agencies involved in the care of the patient or family.

(5) Referral of the patient to a home health care agency when the patient's status and care needs are no longer limited to supportive services.

(d) An agency's sampling methodology shall be defined in its quality assurance program policies and procedures. The sample of patient records reviewed each quarter shall be according to the following ratios:

(1) Eighty (80) or less cases; eight (8) records;

(2) Eighty-one (81) or more cases; ten percent (10%) of caseload for the quarter to maximum of twenty-five (25) records.

(e) An annual written report of the agency's quality assurance program shall summarize all findings and recommendations resulting from the quality assurance activities. This report and documentation of all actions or implementations on the findings or recommendations included in the report shall be available to the commissioner.

(Effective December 28, 1992)