6310.1 Each provider shall establish and adhere to policies and procedures governing quality improvement (“Quality Improvement Policy”).

6310.2 The Quality Improvement Policy shall require the provider to adopt a written quality improvement (“QI”) plan describing the objectives and scope of its QI program and requiring provider staff, client, and family involvement in the QI program.

6310.3 The Department shall review and approve each provider’s QI program at a minimum as part of the certification and renewal of certification process. The QI program shall submit data to the Department upon request.

6310.4 The QI program shall be directed by a coordinator (“QI Coordinator”) who has direct access to the Program Director if applicable. In addition to directing the QI program’s activities, the QI Coordinator shall also review unusual incidents, deaths, and other sentinel events; monitor and review utilization patterns; and track consumer complaints and grievances. The QI Coordinator shall be one of the following:

(a) Physician;

(b) Psychologist;

(c) Licensed Independent Clinical Social Worker (“LICSW”);

(d) Advanced Practice Registered Nurse (“APRN”);

(e) Licensed Professional Counselor (“LPC”);

(f) Licensed Marriage and Family Therapist (“LMFT”);

(g) Registered Nurse (“RN”);

(h) Licensed Independent Social Worker (“LISW”);

(i) Licensed Graduate Professional Counselor (“LGPC”);

(j) Licensed Graduate Social Worker (“LGSW”);

(k) Certified Addictions Counselor (“CAC”) I or II;

(l) Physician Assistant (“PA”); or

(m) An individual with a Bachelors’ Degree and a minimum of two (2) years of relevant, qualifying experience, such as experience in behavioral health care

delivery or health care quality improvement initiatives.

6310.5 The QI program shall be operational and shall measure and ensure at least the following:

1. (a) Easy and timely access and availability of services;
2. (b) Treatment and prevention of acute and chronic conditions;
3. (c) Close monitoring of high-volume services, clients with high risk conditions, and services for children and youth;
4. (d) Coordination of care across behavioral health treatment and primary care treatment settings;
5. (e) Compliance with all certification standards;
6. (f) Adequacy, appropriateness, and quality of care for clients;
7. (g) Efficient utilization of resources;
8. (h) Client and family satisfaction with services;
9. (i) Quarterly random samplings of client outcomes, including but not limited to biological markers such as drug/alcohol screening results, in a format approved by the Department; and
10. (j) Any other indicators that are part of the Department QI program for the larger system.

6310.6 When the provider identifies a significant problem or quality of service issue, the provider shall notify the Department. The provider shall act to correct the problem or improve the effectiveness of service delivery, or both, and shall assess corrective or supportive actions through continued monitoring.

6310.7 Providers certified through Deemed Status or accredited by nationally-recognized bodies may submit their QI program accepted by that body to fulfill the requirements in § 6310.5.

SOURCE: Final Rulemaking published at 62 DCR 12056 (September 4, 2015); as amended by Final Rulemaking published at 67 DCR 011585 (October 9, 2020).