CHHA Annual Program Review Template

CHHA Annual Program Review Template
A complete annual program evaluation template for Certified Home Health Agencies, built around the QAPI annual review requirement at 42 CFR 484.65 and 10 NYCRR Part 763. Section 1 walks the reviewer through seven program domains with Yes/No scoring, comments, and corrective action columns: Organization; Administration (Governing Body, PAC/QAPI, Administrative Personnel, Personnel, Reports and Records, Fiscal); Admission and Discharge; Skilled Nursing; Therapy Services; Home Health Aide Services; and Medical Social Work. Statistical tables capture visit volume by discipline, referrals, admissions, discharges, and diagnosis breakdowns, followed by recommendations for corrective action, the four required conclusions (appropriate, adequate, effective, efficient), and a narrative summary with operational highlights, quality improvement summary, prior-period goal achievement, and goals for the next period. Signature lines for the QAPI Coordinator and Governing Body representative close the document. A branded, editable Word template ready to customize with your agency name.