Pa. Code 5240.61

Quality improvement requirements

An Intensive Behavioral Health Services (IBHS) agency must establish and implement a written quality improvement plan that includes an annual review of service quality, timeliness, appropriateness, individual records, and satisfaction data. The agency must prepare an annual quality report analyzing review findings and identifying corrective actions, make the report publicly available upon request, and notify youth, young adults, and their parents or guardians at admission that they may request a copy.

55 Pa. Code § 5240.61 - Quality improvement requirements 

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(a)
 An IBHS agency shall establish and
 implement a written quality improvement plan that meets the following
 requirements:
(1)
 Provides for an annual
 review of the quality, timeliness and appropriateness of services that includes
 the following:
(i)
 Review of individual
 records.

(ii)
 Review of individual
 and family satisfaction information.

(iii)
 Assessment of the outcomes of services
 delivered and if ITP goals have been completed.

(iv)
 Evaluation of compliance with the
 agency's approved service description and licensure requirements in this
 chapter.

(2)
 Identifies
 the methodology for the review of agency and individual records that includes
 the following:
(i)
 Method for establishing
 sample size of agency and individual records.

(ii)
 Frequency of review of the agency and
 individual records to prepare for the annual quality review in subsection
 (a)(1).

(iii)
 Staff's
 qualifications who perform the review.

(b)
 An IBHS agency shall prepare an annual
 quality report that includes the following: 
 
(1)
 Analysis of the findings of the annual
 quality review required under subsection (a)(1).

(2)
 Identification of the actions to address
 annual review findings.

(c)
 An IBHS agency shall make annual quality
 reports available to the public upon request.

(d)
 An IBHS agency shall provide written
 notification that a copy of the annual quality report may be requested by a
 youth, young adult or parent, legal guardian or caregiver of a child, youth or
 young adult upon admission to services.

Notes

55

 Pa. Code §
 
5240.61

This section cited in 55 Pa. Code §
 
5240.42
 (relating to agency
 records).

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