Section 1000, Introduction

Revision 16-1; Effective February 3, 2016



The Quality Monitoring Program Provider Manual provides information about the activities of the Quality Monitoring Program (QMP), nursing facility quality review process, early warning system (EWS), contact information and additional resources.

QMP Purpose

The purpose of the QMP is to detect, through the EWS, conditions inside Texas nursing facilities that could be detrimental to the health, safety and welfare of facility residents. Quality monitors (QMs) are nurses, pharmacists and dietitians who may:

  • recommend procedural and policy changes;
  • provide staff training and in-servicing;
  • be available for technical assistance; and
  • educate on evidence-based best practices (EBBP) that will ensure facilities are doing the right thing, in the right way and at the right time, for the right person to achieve the best possible outcomes.


Long-term care facilities will use on-going quality improvement activities to ensure they are doing the right thing, in the right way and at the right time, for the right person to achieve the best possible resident outcomes.


The mission is to achieve optimal resident outcomes through the consistent application of evidence-based resident care planning and care practices.


The information gathered through this process by the Texas Department of Aging and Disability Services (DADS) QMP staff is kept strictly confidential.

QMP History

In 2001, the 77th Texas Legislature, Regular Session, passed the Texas Long-Term Care Facility Quality Improvement Act, Senate Bill (SB) 1839. This bill had several components, one of which was to establish the QMP. 

Collaborative Relationships Promote Quality Improvement

The QMP function is intended to provide technical assistance to nursing facility providers, in a collaborative relationship that would promote quality improvement beyond minimal compliance with state and federal standards. SB 1839 requirements for the QM function include the development of a risk assessment tool called the EWS, which is used to alert DADS program staff to the need for comprehensive technical assistance in high-risk facilities. Facilities with a history of patient care deficiencies or that are identified as medium risk based on the facility’s EWS scores are given priority for quality monitoring visits. Rapid Response Team (RRT) visits are scheduled for those facilities identified as high risk through the EWS or facilities that have had three violations in a 24-month period that constitute an immediate threat to the health and safety of a resident due to abuse or neglect. Nursing facilities are also able to request quality monitoring or RRT visits.

The QM function consists of routine technical assistance (monitoring) visits, as well as more intensive assistance focused on those facilities identified by the EWS (RRT visits). During those visits, QMP staff assess the overall quality of life in the facility, as well as specific conditions related to quality of care. As required by statute, all QMs are nurses, dietitians or pharmacists. QMs are located in DADS regional offices throughout Texas, with each monitor assigned to specific areas of the state and specific nursing facilities within those areas. The QMs assigned to a specific facility are the ones a provider should contact:

  • regarding a visit or a report;
  • implementing best practices; and
  • requesting an in-service or training.

Not a Regulatory Function

The QMP is not a regulatory program. QMs do not cite deficient practices. The QMP goal is to establish a partnership with nursing facilities and to work with facility staff to implement care approaches that can improve resident outcomes.

There are significant differences between QM visits, and the visits conducted by staff from DADS Regulatory Services Division. The QMP focuses on evidence-based best practices while surveyors focus on compliance with minimum standards. Best practice emphasizes achieving the best resident outcomes, with the goal of helping Texas facilities achieve more than the minimum standard required by state and federal regulations. The QMP is committed to working with facility staff to identify opportunities for improving resident care through the use of evidence-based best practices.

QMs are required to immediately report any condition observed that creates an immediate threat to the health or safety of a resident. If such a condition is identified by a QM, notification will be made to the facility administrator, the QM’s supervisor and to law enforcement, adult protective services, other agencies or another program within DADS, as appropriate, or as required by law.