1. (a) The HCSPA shall develop and implement a quality improvement program that reviews policies and services and maximizes quality by preventing or correcting identified problems.
2. (b) As part of the HCSPA’s quality improvement program, a quality improvement committee shall be established.
3. (c) The HCSPA shall determine the size and composition of the quality improvement committee based on the services provided.

4. (d) The quality improvement committee shall:

   1. (1) Determine the indicators to be monitored;
   2. (2) Evaluate the information that is gathered;
   3. (3) Determine the action that is necessary to correct identified problems;
   4. (4) Recommend corrective actions to the licensee; and
   5. (5) Evaluate the effectiveness of the corrective actions.
5. (e) The quality improvement committee shall meet at least every 6 months.
6. (f) The quality improvement committee shall generate dated, written minutes after each meeting.
7. (g) Documentation of all quality improvement activities shall be maintained on-site for at least 2 years.

Source. #9522, eff 7-25-09, EXPIRED: 7-25-17 New. #12504, INTERIM, eff 3-24-18, EXPIRED: 9-20-18 New. #12702, eff 1-3-19