Affordable Care Act Update: Quality Assessment and Performance Improvement Program - Still a Work in Progress

One year ago, Weltman Health Matters introduced and examined the Quality Assessment and Performance Improvement program (QAPI).  Since the initial introduction, Weltman Health Matters has provided updates as the Centers for Medicare & Medicaid Services (CMS) provides further information, resources and tools to assist facilities in their QAPI programs.

QAPI is found within the Affordable Care Act (ACA), specifically section 6102(c).¹  The purpose of QAPI is to require nursing homes to develop and implement appropriate plans of action to correct identified quality deficiencies.²  The CMS, the government agency responsible for the implementation of QAPI, described QAPI as the merger of two complementary approaches to quality management, Quality Assurance (QA) and Performance Improvement (PI).³  QAPI is intended to be a data driven comprehensive approach to improving quality of life, care and services in nursing homes.⁴  While the vast majority of facilities already strive toward this objective, the goal remains, to do so and assure QAPI compliance.      

Comprehensive legislation, like the ACA, can be described as a directive or requirement placed on a section of the community or an industry.  How the legislation will be applied or implemented is left to the regulations that follow.  Regulations are designed to guide the activity of those required to follow the legislation and to further ensure uniform application of the law.  In essence, the regulations will be the rules that nursing homes will be required to follow.  To date, the CMS has yet to issue any regulation regarding QAPI.  Accordingly, we know that nursing facilities, including skilled, are required to develop and implement appropriate plans of action to correct identified quality deficiencies; however, they are still left wondering what is or will be minimally required to remain in conformity with QAPI.

In June of 2013, the CMS did release educational materials to help facilities establish a foundation to support and sustain a QAPI program.  The materials are available on the CMS website.⁵  Because the materials were approved and released by the CMS—the entity ultimately responsible for drafting the QAPI regulations—the materials should be considered as great insight as to what the regulations will ultimately require. 

The CMS website provides tools such as a self-assessment designed to target areas your facility needs to work on in order to establish an effective QAPI in your organization. 

During the June 13, 2013 CMS SNF Open Door Forum, a key topic on the agenda was QAPI.⁶  During the call, the speakers announced that a regulation is still being worked on, and that the materials provided on the CMS website serve as a good jumping-off point for long term care facilities that are looking to get a head start on this initiative.⁷  Accordingly, leaders or key stakeholders at your facility or facilities should take the time to carefully review the materials on the CMS website.  Waiting for the CMS to announce a regulation before preparing for the regulation will certainly place your organization in a precarious spot as each facility will have one year from the date of the regulation to be in compliance.⁸  Weltman Health Matters will continue to monitor CMS for the release of the forthcoming proposed regulations. Historically, promulgation of proposed regulatory guideline is released by CMS in the Spring or Fall through the Unified Agenda.⁹  If you have additional questions regarding QAPI please feel free to contact our firm.

¹ 42 CFR, Part  6102(c)
² http://cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/qapidefinition.html
³ Id
⁴ Id
⁵ http://cms.gov/Medicare/Provider-Enrollment-and-Certification/QAPI/NHQAPI.html
⁶ http://cmscompliancegroup.com/tag/open-door-forum/
⁷ Id
⁸ 42 USC § 1320a–7j(c)(1).
⁹ http://www.reginfo.gov/public/do/eAgendaMain