Section He-E 805.10 - Quality Management(a) On a quarterly basis, case management agencies shall conduct a participant record review to evaluate the delivery of services identified in the comprehensive care plan to ensure that participants' needs are being met in the community, and shall document the results of the review in a quarterly quality management report, including: (1) The number of records reviewed;(2) A summary of the review results;(3) A description of any deficiencies identified;(4) The remedial action taken or planned to address the deficiencies identified in (3) including the dates action was taken or will be taken; and(5) A summary of unmet service needs.(b) On a quarterly basis, case management agencies shall conduct a review of all reported complaints, incidents, and sentinel events related to the delivery of services identified in the comprehensive care plan, and shall document the results of the review in a quarterly quality management report, including: (1) The number of reported complaints, incidents and sentinel events;(2) A summary of the review results;(3) A description of the deficiencies identified; and(4) The remedial action taken or planned to address the deficiencies identified in (3) including the dates action was taken or will be taken.(c) Case management agencies shall plan and take any remedial action necessary to address deficiencies in service delivery identified in the quarterly quality management reports in (a) and (b) above.(d) Case management agencies shall retain the quarterly quality management reports in (a) and (b) above for 2 years and make them available to the department upon request.(e) Case management agencies shall retain clinical records: (1) To support claims submitted for reimbursement for a period of at least 6 years from the date of service; or(2) Until resolution of any legal action(s) commenced during the 6-year period.(f) Case management agencies shall be subject to monitoring visits by BEAS to ensure that services are provided in accordance with He-E 805.(g) Monitoring visits shall:(1) Be announced or unannounced;(2) Occur at least annually;(3) Include, but not be limited to:a. A review of participant case records;b. A review of the portion of employee records pertinent to the provider qualification requirements of He-805; andc. A review of the quarterly quality management reports in (a) and (b) above and(4) Be made during the agencies regular business hours.N.H. Code Admin. R. He-E 805.10
Amended by Volume XXXVI Number 36, Filed September 8, 2016, Proposed by #11167, Effective 8/25/2016, Expires 2/21/2017.Amended by Volume XXXVII Number 10, Filed March 9, 2017, Proposed by #12115, Effective 2/22/2017, Expires 2/22/2027.