Quality Assurance Performance Improvement

“Nursing homes are in the best position to assess, evaluate and improve their care and services because each home has first-hand knowledge of their own organizational systems, culture and history.” –Centers for Medicare and Medicaid Services resource QAPI at a Glance

The Affordable Care Act of 2010 requires that all skilled nursing care centers develop a QAPI program. One year after a final rule for QAPI is issued; all nursing centers must have in place and implement an acceptable QAPI plan.

The statute also requires the Centers for Medicare & Medicaid Services (CMS) to develop a prototype QAPI program, establish standards, and provide technical assistance to centers on the development of best-practices in order to meet such standards.

Tools and Worksheet are from the CMS QAPI Program Resource are available as PDFs under each QAPI Element or can be accessed online.

Click here for the QAPI Written Plan How-To Guide (Nov. 2016)

What is QAPI?

QAPI merges two complementary approaches to quality–Quality Assurance (QA) and Performance Improvement (PI) focusing on improving the quality of life, care and services in nursing centers. CMS offers an overview of QAPI titled QAPI at a Glance: A Step by Step Guide to Implementing Quality Assurance and Performance Improvement (QAPI) in Your Nursing Home.

Both QA and PI involve the use of a systematic, comprehensive, data-driven approach, but they differ in key ways:

  • Quality Assurance (QA) = the process of meeting quality standards and assuring that care reaches an acceptable level.
  • Performance Improvement (PI) = continuously analyzing your performance and developing systematic efforts to improve it; also known as Quality Improvement.


QAPI Detailed Checklist

The New Requirements of Participation (RoP) includes a section on quality assurance and performance improvement (QAPI) (§ 483.75), which requires facilities to develop, implement and maintain an effective comprehensive, data-driven QAPI program that focuses on systems of care, outcomes of care and quality of life.


QAPI requirements will be enforced over three phases (I- Nov. 2016, II- Nov. 2017, and III- Nov. 2019). Most of the requirements for the QAPI program will be implemented in Phase III. The QAPI Detailed Checklist Tool highlights the QAPI requirements that must be implemented in Phase I (Nov. 28, 2016).

Resources: The resources below offer an overview of the requirements by phase and implementation strategies and tips for QAPI.

  1. Tool: QAPI Detailed Checklist
  2. QAPI Writter Plan How-to Guide
  3. PHCA QAPI Web Page
  4. Full RoP Intensive Slide Deck
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