Quality Assurance/Risk Management Committee (QARMC) - Charter

Refer to: OQ

1. PURPOSE. The purpose of the Quality Assurance Risk Management Committee (QARMC) is to provide senior-level oversight and management of complex adverse events and certain administrative and operational matters, including those involving significant fraud, waste, abuse, and employee misconduct: 1) within the Indian Health Service (IHS); or 2) involving U.S. Public Health Service Commissioned Corps officers or civilian Federal employees on detail or assignment through the IHS to non-federally operated facilities. The QARMC is a component of the overall Enterprise Risk Management governance structure. It is not intended to replace or duplicate required reporting systems to state and Federal agencies or law enforcement. It is intended to ensure Agency-wide accountability and effectiveness of those internal and external reporting systems, necessary management responses, and swift and effective corrective actions related to patient safety events and operational and administrative matters that are reported to the QARMC.
2. AUTHORITY. 25 U.S.C. § 1661(c).
3. MEMBERSHIP.
   1. Membership on the QARMC will include the following Agency officials (or acting official when a position is vacant):
      1. Deputy Director for Quality Healthcare and Enterprise Risk Management, IHS (to serve as Executive Sponsor and the QARMC Co-Chair).
      2. Chief Medical Officer, IHS (to serve as the QARMC Co-Chair).
      3. Deputy Director for Management Operations, IHS.
      4. Deputy Directors for Field Operations, IHS.
   2. Collaboration and consultation as needed by the QARMC with subject matter experts, which can include, but are not limited to, representatives from:
      1. Office of Inspector General – Office of Investigations, Department of Health and Human Services (HHS).
      2. Office of the General Counsel, HHS.
      3. Office of Human Resources, IHS Headquarters (HQ).
      4. Office of Quality, (OQ) IHS HQ.
      5. Office of Clinical and Preventive Services, IHS HQ.
      6. Area Directors, IHS.
4. RESPONSIBILITIES.
   1. Co-Chairs. The QARMC Co-Chairs preside over and coordinate QARMC meetings. The QARMC Co-Chairs advise and inform the IHS Director and Deputy Director on issues, trends, and actions to address challenges as identified and initiated by the QARMC. The responsibilities of the QARMC members described below also apply to the QARMC Co-Chairs.
   2. Members. 
      1. The QARMC members are responsible for attending meetings called by the QARMC Co-Chairs and providing recommendations and timely follow-up to any action items stemming from the meetings after review of the Rolling Action Item List (RAIL).
      2. The QARMC members are responsible for evaluating management responses in the RAIL and initiating action to ensure enterprise-wide accountability and effectiveness of reporting systems and corrective actions.
      3. The QARMC members will acknowledge that they will review and handle materials that are deemed privileged and confidential under the Privacy Act, Health Insurance Portability and Accountability Act, 25 U.S.C. § 1675, 42 Code of Federal Regulations (C.F.R.) Part 2, 5 C.F.R. Part 293, and other Federal laws and regulations. The QARMC members understand that they are responsible for complying with the requirements of all Federal privilege and confidentiality laws.
      4. The QARMC may create committees of subject matter experts as needed to perform work as directed by the QARMC to support the QARMC purpose.
      5. The QARMC will send provider issues, including initial and ongoing credentialing and privileging, peer review, or other provider-related events in violation of IHS policy, to the Agency Clinical Credentials Committee (ACCC). The QARMC will follow up with the ACCC for closure of the matter.
      6. The QARMC members are responsible for ensuring that Area Directors and HQ Office Directors are reporting high-risk issues on the RAIL as described above in Section 1 and in the QARMC procedures document. This will allow the QARMC to provide the necessary analysis and oversight of actions the QARMC deems necessary in response to high-risk issues.
      7. The QARMC members are responsible for reviewing appropriate documentation to competently make a determination about cases submitted on the RAIL and maintain appropriate records to demonstrate that the QARMC is meeting its purpose as described above in Section 1. The QARMC member, or the designee, will record the actions and decisions of the Committee.
   3. Office of Quality, IHS. The Director, OQ, or the designee, is responsible for coordinating the confidential QARMC meeting records, compiling the master RAIL, and documenting QARMC decisions that will drive new or updated policy directives or Agency actions. The Director, OQ, or the designee, is also responsible for defining indicators that capture performance data, data collection methods and timelines, and creating an analysis plan and reporting template for the QARMC. The Director, OQ, or the designee, will prepare timely and accurate information for presentation to the QARMC with evidence to support actions completed.
   4. Area Directors and HQ Office Directors, IHS. Area Directors and HQ Office Directors are responsible for reporting high-risk issues on the RAIL as described above in Section 1 and in the QARMC Procedures. This will allow the QARMC to provide the necessary analysis and oversight of actions the QARMC deems necessary in response to the high-risk issues. As requested, Area Directors and HQ Office Directors will prepare timely and accurate information about cases for presentation to the QARMC with evidence to support actions completed.
   5. Subject Matter Experts. At the direction of an Area Director or HQ Office Director, subject matter experts advising or conducting work on behalf of the QARMC and others who have access to or manage QARMC-related information will prepare timely and accurate information for presentation to the QARMC with evidence to support actions completed. Subject matter experts will support the QARMC to complete the review of the RAIL and conclude required actions.
5. MEETINGS.
   1. The QARMC will meet monthly.
   2. Ad Hoc Meetings. The QARMC will meet as needed to address new issues as they are reported to the QARMC.
6. CONFIDENTIALITY AND PRIVILEGE.

   The QARMC members and subject matter experts advising or conducting work on behalf of the QARMC and others who have access to or manage QARMC-related information are bound by privileges and confidentiality requirements that may arise under Federal laws and regulations, including but not limited to 25 U.S.C. § 1675. Only
   non-Bargaining Unit Employees are allowed to access QARMC data and related information. Unauthorized disclosure of privileged and confidential information, including with others in the IHS who do not have a need to know, may result in disciplinary action up to and including termination, or other corrective action. 

   All documents that are medical quality assurance records under 25 U.S.C. § 1675 will be properly labeled.
7. SUPERSEDURE. This circular supersedes the Indian Health Manual Circular No. 19-07, “Quality Assurance Risk Management Committee (QARMC) – Charter,” dated November 18, 2019.
8. EFFECTIVE DATE. This revised charter becomes effective on the date of signature.

Distribution: IHS-wide
Date: 11/25/2024