N.Y. Comp. Codes R. & Regs. tit. 14 § 819.7

Current through Register Vol. 46, No. 45, November 2, 2024

Section 819.7 - Quality improvement and utilization review

(a) Each substance use disorder residential service shall establish and implement a quality improvement plan and utilization review plan in accordance with this section. The utilization review requirement may be met by the following:

(1) the service may perform its utilization review process internally; or

(2) the service may enter into an agreement with another organization, competent to perform utilization review, to complete its utilization review process.

(b) The utilization review plan shall include procedures for ensuring that admissions are based on the program's admission criteria that retention and discharge criteria are met, and that services are appropriate. The utilization review plan shall consider each resident's need for continued treatment, the severity of the resident's substance use disorder(s), and the continued effectiveness of, and progress in, treatment.

(c) Each residential service shall establish a written quality improvement plan in accordance with this section.

(1) The quality improvement plan shall identify clinically relevant quality indicators that are based upon professionally recognized standards of care. This process shall include but not be limited to:

(i) no less than quarterly self-evaluations which may include an independent peer review process as discussed below, to ensure compliance with applicable regulations and performance standards;

(ii) findings of other management activities, including but not limited to; utilization reviews, incident reviews, and reviews of staff training, development and supervision needs;

(iii) surveys of resident satisfaction; and

(iv) analysis of treatment outcome data.

(2) The residential service shall prepare an annual report and submit it to the governing authority. This report shall document the effectiveness and efficiency of the service in relation to its goals and indicate any recommendations for improvement in its services to residents, as well as recommended changes in its policies and procedures.

(3) The purpose of independent peer review is to review the quality and appropriateness of residential services. The review is to focus on such services and the substance use disorder service system rather than on the individual practitioners. The intent of the independent peer review process is to improve continuously the residential services provided to individuals with substance use disorders.

N.Y. Comp. Codes R. & Regs. Tit. 14 § 819.7

Amended New York State Register September 14, 2022/Volume XLIV, Issue 37, eff. 10/1/2022