Section 11-800-34 - Quality assurance(a) The case management agency shall have internal policies and procedures for continuous quality improvement. The program shall include at least annual monitoring of the case management agency's compliance with licensing requirements, and plans for corrective action measures and their implementation dates, as appropriate.(b) The case management agency shall have internal risk management policies and procedures that provide for ongoing monitoring and assessment of reports of adverse events, and analysis for trends in adverse events, The policies and procedures shall require:(1) All service providers serving the client to verbally report adverse events to the case management agency within twenty-four hours of the occurrence;(2) A written report to be sent to the case management agency within seventy-two hours, excluding weekends and holidays, following the verbal report required in paragraph (1);(3) An evaluation of each report of adverse event by the case management agency to determine the appropriateness of actions taken and completion of the report and follow-up process;(4) A copy of the original report and a summary to be provided to the department of the case management agency's evaluation of any report of adverse events and any action taken by the case management agency, including adjustments to the client's service plan, as appropriate. The original report and summary shall be received by the department within seventy-two hours, excluding weekends and holidays, after the case management agency receives a written report of an adverse event; and(5) Quarterly assessment of reports of adverse events by the case management agency to determine trends and to document preventative actions taken when significant trends are noted.(c) The case management agency shall have policies and procedures requiring all service providers serving the client to inform the case management agency of any changes occurring in the client's behavior and functioning that may necessitate a change and update of the client's service plan. (1) The case management agency shall require a verbal report from all service providers serving the client within twenty-four hours of the occurrence of any of the following: (A) Changes in the client's condition requiring emergency treatment;(B) Hospitalization of the client;(C) Environmental changes or disasters affecting the delivery of services to the client; and(D) Death of the client. If any of the preceding events also constitutes an adverse event, the requirements of subsection (b)(1) shall be apply.
(2) A written report shall be sent to the case management agency within seventy-two hours, excluding weekends and holidays, following the verbal report required in paragraph (1).(3) The case management agency shall have procedures for handling reports required in paragraph (1).(d) The case management agency shall be subject to investigation by the department at any time. The investigation may be announced or unannounced and may include, but is not limited to, one or more of the following:(1) Reviews of administrative, fiscal, personnel, and client records;(2) Inspection of service sites;(3) Service site visits to interview clients and to observe personnel and subcontractors providing services; and(4) Interviews with case management personnel and service sub-contractors.[Eff 11/13/2018] (Auth: HRS §§ 321-481, 321-482, 321-485, 346-14) (Imp: HRS §§ 321-481, 321-482, 321-485, 346-14)