Section 7.12.460. Periodic program evaluation and quality assurance.

	(a)  At least once each year, a frontier extended stay clinic must evaluate, or arrange for evaluation of, its total program to determine whether  
		(1) the utilization of services was appropriate;  
		(2) established policies were followed; and  
		(3) any changes are needed.  
	(b)  The evaluation required under (a) of this section must include review of  
		(1) the utilization of clinic services, including, at a minimum, the number of patients served, the services provided, and the number of patients who received each service;  
		(2) all patient care services and other services affecting patient health and safety; and  
		(3) the clinic's health care policies.  
	(c)  The clinic must have an effective quality assurance program to evaluate the quality and appropriateness of diagnoses and treatment provided at the clinic and of treatment outcomes. The quality assurance program must require that  
		(1) at regular intervals, no less than once each year, a physician and a mid-level practitioner, either separately or together, review the records for all patients admitted for an extended stay during the review period, and the records selected under (2) of this subsection; the review under this paragraph must include an evaluation of the appropriateness of the diagnoses and treatment provided, treatment outcomes, and the accuracy of the records; the physician shall document the review and any recommendations; the clinic must provide documentation of the review to the department upon request;  
		(2) for the review described in (1) of this subsection, the clinic develop policies and procedures for the random sampling of medical records for each type of service provided during the review period in addition to extended stay services; this sampling must include  
			(A) at least 25 of every 1,000 encounters if the number of records for extended stay patients is less than 2.5 percent of the total encounters during the review period; or  
			(B) at least 10 of every 1,000 encounters if the number of records for extended stay patients is 2.5 percent or more of the total encounters during the review period;  
		(3) the physician and the mid-level practitioner conducting a review under this subsection be on the clinic's staff or under contract with the clinic; and  
		(4) the clinic staff, after each evaluation  
			(A) consider the findings and any recommendations of the medical staff and take corrective action if necessary; and  
			(B) document the outcome of any corrective action.  

Authorities

47.32.010;47.32.030

Notes

Reference

7 AAC 12.465

Authority

AS 47.32.010 AS 47.32.030

History

Eff. 12/3/2006, Register 180