485.641—Condition of participation: Periodic evaluation and quality assurance review.
(a) Standard: Periodic evaluation—
(1)
The CAH carries out or arranges for a periodic evaluation of its total program. The evaluation is done at least once a year and includes review of—
(i)
The utilization of CAH services, including at least the number of patients served and the volume of services;
(2)
The purpose of the evaluation is to determine whether the utilization of services was appropriate, the established policies were followed, and any changes are needed.
(b) Standard: Quality assurance.
The CAH has an effective quality assurance program to evaluate the quality and appropriateness of the diagnosis and treatment furnished in the CAH and of the treatment outcomes. The program requires that—
(1)
All patient care services and other services affecting patient health and safety, are evaluated;
(3)
The quality and appropriateness of the diagnosis and treatment furnished by nurse practitioners, clinical nurse specialists, and physician assistants at the CAH are evaluated by a member of the CAH staff who is a doctor of medicine or osteopathy or by another doctor of medicine or osteopathy under contract with the CAH;
(4)
The quality and appropriateness of the diagnosis and treatment furnished by doctors of medicine or osteopathy at the CAH are evaluated by—
(iii)
One other appropriate and qualified entity identified in the State rural health care plan; and
(5)
(i)
The CAH staff considers the findings of the evaluations, including any findings or recommendations of the QIO, and takes corrective action if necessary.
(ii)
The CAH also takes appropriate remedial action to address deficiencies found through the quality assurance program.
[58 FR 30671, May 26, 1993, as amended at 62 FR 46037, Aug. 29, 1997; 63 FR 26359, May 12, 1998]