SECTION 13.481. Quality Improvement Structure for HCCs

(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.

Source Note: The provisions of this §13.481 adopted to be effective March 31, 2013, 38 TexReg 2100