Section 51.25. Quality management

(a) A provider shall meet the QM plan criteria developed by the Department.

(b) The provider shall create and implement a QM plan.

(c) The provider shall evaluate the following when developing a QM plan:

(1) The manner in which the provider will meet the Department’s QM plan criteria.

(2) The provider’s quarterly performance review data and available reports in HCSIS.

(3) The results from provider monitoring and SCO monitoring.

(4) Compliance with the requirements in 42 CFR 441.302 (relating to state assurances).

(5) Incident management data, including data on the incident target under § 51.17 (relating to incident management).

(6) Results of satisfaction surveys and reviews of grievances.

(d) The provider shall include the following criteria when developing a QM plan:

(1) Goals of the QM plan, which include how the provider will meet Department priorities that are published as a notice in the Pennsylvania Bulletin.

(2) Target objectives that support each goal.

(3) Performance measures the provider will use to evaluate progress in achieving the target objectives.

(4) The data source for each performance measure.

(5) The person responsible for the QM plan.

(6) Actions to be taken to meet the target objectives.

(e) A provider shall update its QM plan at least every 2 years.

(f) The provider shall submit a copy of its QM plan and verification that the provider reviewed performance data to the Department or the Department’s designee upon request.

(g) This section does not apply to an SSW provider and to a provider of HCBS in the Adult Autism Waiver.