Section 16.03.09.577 - CHIS: QUALITY ASSURANCEThe Department will establish performance criteria to meet federal assurances that measure the outcomes and effectiveness of the CHIS. Quality assurance activities will include the observation of service delivery with participants, face-to-face visits to review program protocol, and review of participant records maintained by the provider. All CHIS providers must grant the Department immediate access to all information requested to review compliance with these rules.
01.Quality Assurance. Quality assurance consists of reviews to assure compliance with the Department's rules and regulations for CHIS. The Department will visit providers to monitor outcomes, assure treatment fidelity, and assure health and safety. The Department will also gather information to assess family and participant satisfaction with services. These findings may lead to quality improvement activities to enhance provider processes and outcomes for the participant. If problems are identified that impact health and safety or are not resolved through quality improvement activities, implementation of a corrective action process will occur.02.Quality Improvement. Quality improvement consists of the Department working with the provider to resolve identified issues and enhance services provided. Quality improvement activities may include any of the following:b. Technical assistance and recommendations; or03.Corrective Action. Corrective action is a formal process used by the Department to address significant, ongoing, or unresolved deficient practices identified during the review process as provided in Section 205.03 of these rules. Corrective action, as outlined in the Department's corrective action plan process, includes: a. Issuance of a corrective action plan;b. Referral to Medicaid Program Integrity Unit; orc. Action against a provider agreement.Idaho Admin. Code r. 16.03.09.577