6 Colo. Code Regs. § 1011-3-7

Current through Register Vol. 47, No. 20, October 25, 2024

Section 6 CCR 1011-3-7 - STANDARDS GOVERNING CIHCS AGENCY OPERATIONS

7.1 A CIHCS Agency shall:

7.1.1. As necessary, refer consumers to a higher level of medical care and/or to other appropriate resources that may assist in the resolution of other issues identified in the initial and subsequent assessments;

7.1.2 Not utilize its license to circumvent licensing requirements of other facility or agency services;

7.1.3 Only enroll consumers with the reasonable expectation their needs can be met.

A) The Agency and consumer shall agree to the tasks to be provided and the frequency of visits.

B) If the consumer's service plan requires care or services to be delivered at specific times, the Agency shall ensure it either employs qualified staff in sufficient quantity or has other effective back-up plans to ensure the needs of the consumer are met.

C) If applicable, to ensure the needs of the consumer are met, the Agency shall provide the consumer with its after-hours contact information and/or with contact information for the Agency's back-up provider.

D) In the event of the need to alter the consumer's agreed-upon schedule of visits, the consumer shall be notified as soon as practicable. If the consumer has time-sensitive needs, the Agency shall initiate effective back-up plans to ensure patient safety.

E) If there is a missed visit, services shall be provided as agreed upon by the consumer and Agency.

7.1.4 Ensure that its operation and staff utilization will not place CIHCS consumers at risk of harm or disrupt any other Agency services, including emergency services, the Agency may be authorized to provide.

7.1.5 Ensure that its providers document each consumer visit/contact and include such documentation in the consumer's records.

7.1.6 Document evidence of the minimum qualifications and competencies of the Agency's medical director(s) and the administrator and his/her qualified substitutes.

7.1.7 Ensure that its CIHCS providers that are licensed, certified or registered meet the requirements for their practice or profession.

7.2Standards for Quality Management Program

7.2.1. Every CIHCS Agency applicant or licensee shall establish and implement a quality management program that is appropriate to the size and type of the agency, evaluates the quality of consumer care and safety, and complies with the requirements of this section.

7.2.2 The program shall include, at minimum:

A) A general description of the types of cases, problems, or risks to be reviewed and criteria for identifying potential risks, including without limitation any incidents that may be required by Department regulations to be reported to the Department;

B) Identification of the personnel responsible for coordinating quality management activities, the means of reporting to the Agency administrator, and the prescribed time within which the reporting must occur;

C) A description of the method(s) for:

i) Investigating and analyzing the frequency and causes of individual problems and patterns of problems;

ii) Taking corrective action to address the problems, including prevention and minimizing problems or risks;

iii) Evaluating corrective action[s] to determine the effectiveness of such action[s];

iv) Coordinating all pertinent case, problem, or risk review information with other applicable quality assurance and/or risk management activities, such as review of consumer care; review of staff or CIHCS provider conduct; the consumer complaint system; and education and training programs;

D) Documentation of required quality management activities, including cases, problems, or risks identified for review; findings of investigations; and any actions taken to address problems or risks; and

E) A schedule for program implementation not to exceed 90 days after the date of the initial inspection.

7.2.3 The CIHCS Agency shall evaluate the discharge planning process periodically for effectiveness.

7.2.4 The CIHCS Agency shall periodically review treatment protocols and compliance with such protocols.

6 CCR 1011-3-7

40 CR 21, November 10, 2017, effective 1/1/2018