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Quality Measurement and Reporting in Indiana

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The state of Indiana has instituted mandatory quality assurance programs for its home health agency as well as health maintenance organizations (HMOs).  The home health agency must develop and implement a quality assessment and performance improvement program, and must take actions that lead to an improvement in the performance of home health agencies.1  Similarly, all HMOs are required to have an internal quality management program to monitor and evaluate health care services provided across all of their institutions.2  The law is very specific as to the structure of the HMO quality program.  Among the requirements, the law requires a written statement of purpose, confidentiality policies, an evaluation system, and a peer review system.3  The HMO is also required to establish a reporting protocol on its quality management activities,4 and allow access to records and quality management data to the Commissioner of Health.5

 

Footnotes

  • 1. 410 Ind. Admin. Code 17-12-2
  • 2. Ind. Code §27-13-6-2
  • 3. Ind. Code §27-13-6-3
  • 4. Ind. Code §27-13-6-7
  • 5. Ind. Code §27-13-6-9

 

Quality Measurement and Reporting in Indiana

Subtopic Statute/Regulation Description
Quality assurance programs for hospitals or public programs Establishment of Performance Criteria and Evaluation Measures Under the CHIP Program – Ind. Code Ann.§ 12-17.6-2-6 Establishment of Performance Criteria and Evaluation Measures Under the CHIP Program The Office of the Children’s Health Insurance Program (...
Hospital Requirements for Addressing Unusual Occurrences or Disasters – 410 Ind. Admin. Code 15-1.2-1 A hospital must have plans to address the review and reporting of unusual occurrences and disasters.  Unusual occurrences or disasters include...
Reportable Events – 410 Ind. Admin. Code 15-1.4-2.2 A hospital’s quality assessment and improvement program must include monitoring for reportable events.  Reportable events include the...
Requirements for the Establishment of the Quality Assessment and Performance Improvement Program by the Home Health Agency – 410 Ind. Admin. Code 17-12-2 The home health agency must develop and implement a quality assessment and performance improvement program, and must take actions that lead to an...
Quality assessment for health plans Health Maintenance Organization Quality Management Program Requirements – Ind. Code Ann.§ 27-13-6-3 The health maintenance organization’s (HMO) quality management program must include the following: 1.      A written...
Requirements for Health Maintenance Organizations' Internal Quality Management Program – Ind. Code Ann.§ 27-13-6-2 All health maintenance organizations (HMOs) are required to have internal quality management programs to monitor and evaluate the health care...
Requirements for Maintenance and Confidentiality of Records of Proceedings for Health Maintenance Organizations – Ind. Code Ann.§ 27-13-6-8 A health maintenance organization (HMO) record all proceedings related to quality management activities and maintain the confidentiality of those...
Requirements for the Establishment and Utilization of Patient Record Systems by Health Maintenance Organizations – Ind. Code Ann.§ 27-13-6-6 A health maintenance organization (HMO) must use a patient record system that allows for retrieval of patient records easily in order to evaluate the...
Requirements for Written Plans that Correct Insufficient Service in Health Maintenance Organization Quality Management Programs – Ind. Code Ann.§ 27-13-6-5 The health maintenance organization’s (HMO) quality management program must contain a written plan for addressing substandard care or to...
Requirements for Written Statement of Quality Management Activities for Health Maintenance Organization Quality Management Programs – Ind. Code Ann. § 27-13-6-4 The health maintenance organization’s (HMO) quality management program must contain a written statement  that includes the following: 1....
Reporting, Use and/or Confidentiality of quality data (Cross reference Privacy & Confidentiality) Hospital Requirements for Addressing Unusual Occurrences or Disasters – 410 Ind. Admin. Code 15-1.2-1 A hospital must have plans to address the review and reporting of unusual occurrences and disasters.  Unusual occurrences or disasters include...
Reportable Events – 410 Ind. Admin. Code 15-1.4-2.2 A hospital’s quality assessment and improvement program must include monitoring for reportable events.  Reportable events include the...
Requirements for Confidentiality of Proceedings and Matters Allowed to be Disclosed – Ind. Code Ann.§34-30-15-1 All proceedings, communications and records of a peer review committee must be confidential.  However, the governing board of a hospital,...
Requirements for the Use of Information for Internal Business Purposes – Ind. Code Ann.§34-30-15-21 The following entities may use information obtained by a peer review committee for a legitimate business purpose: Health care provider; Peer...
Quality Measurement and Reporting Ind. Code Ann. § 12-11-13-10 - Statewide waiver ombudsman maintaining confidentiality and providing coordination The statewide waiver ombudsman receives, investigates and attempts to resolve complaints made by individuals with developmental disabilities who...
Ind. Code Ann. § 12-11-13-9 - Agency providing access to relevant records to statewide waiver ombudsman The statewide waiver ombudsman receives, investigates and attempts to resolve complaints made by individuals with developmental disabilities who...
Ind. Code Ann. § 16-40-4-4 - Development of health care quality indicator data program This law requires that the state department of health develop a health care quality indicator data program by December 31, 2006, and that the plan...
Ind. Code Ann. § 16-40-4-7 - Confidentiality of information collected for health care quality indicator data program This law makes all the information collected through the health care quality indicator data program that can identify an individual confidential, and...
Ind. Code Ann. § 27-13-31-4 - Access to records by HMO to run a quality management program This law allows an HMO to access treatment records related to the diagnosis, treatment and health status of any enrollee during the time that the...
Performance measurement for health care providers or insurance plans Requirements for Health Maintenance Organizations' Internal Quality Management Program – Ind. Code Ann.§ 27-13-6-2 All health maintenance organizations (HMOs) are required to have internal quality management programs to monitor and evaluate the health care...
Requirements for Written Plans that Correct Insufficient Service in Health Maintenance Organization Quality Management Programs – Ind. Code Ann.§ 27-13-6-5 The health maintenance organization’s (HMO) quality management program must contain a written plan for addressing substandard care or to...
Requirements for Written Statement of Quality Management Activities for Health Maintenance Organization Quality Management Programs – Ind. Code Ann. § 27-13-6-4 The health maintenance organization’s (HMO) quality management program must contain a written statement  that includes the following: 1....
Grievance programs (Reporting requirements, Management of grievance reports) Requirements for Provision of a Mechanism to Amend, Access or Supplement Patient-Provided Personal Health Information by Medical Practice Sites – 844 Ind. Admin. Code 5-3-8 All medical practice sites must provide patients a clear mechanism to access, supplement, and amend patient-provided personal health information;...
Quality reporting requirements – providers and health plans Requirements for Reporting of Quality Management Activities by Health Maintenance Organizations – Ind. Code Ann.§ 27-13-6-7 A health maintenance organization (HMO) must establish a mechanism of reporting on quality management activities. Related Laws: Ind. Code § 27-...
Requirements for the Establishment and Utilization of Patient Record Systems by Health Maintenance Organizations – Ind. Code Ann.§ 27-13-6-6 A health maintenance organization (HMO) must use a patient record system that allows for retrieval of patient records easily in order to evaluate the...
External review for insurance and/or peer review purposes (Cross reference to Private Insurance Data and Medical Peer Review) Requirements for the Inspection of Records by the Commissioner of Health – Ind. Code Ann.§ 27-13-6-9 The Commissioner of Health may inspect a health maintenance organization’s (HMO) records related to quality management activities and maintain...
Click on the individual state law in the table above to see our summary of the individual law.


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