2014 Quality Management Program Highlights
|
|
- Derek Hodges
- 8 years ago
- Views:
Transcription
1 2014 Quality Management Program Highlights March
2 Table of Contents Quality Management Program Overview Quality Committees. 5 Data Monitoring... 6 QM/UM Plan Highlights.. 7 Access to and Availability of Care 8 Denial and Appeals Decision Timelines... 9 Monitoring Quality of Care Incident Reporting Preventive Health Highlights.. 13 Quality Management Program Goals Contact Us
3 Quality Management Program: Overview The Value Behavioral Health of Pennsylvania, Inc. (VBH-PA) Quality Management (QM) Program serves as a unifying structure for all HealthChoices quality management activities across all behavioral health services provided to members in thirteen western Pennsylvania counties. VBH-PA recognizes a responsibility to demonstrate a solid commitment to superior clinical quality and service that is consumer-focused, clinically appropriate, cost effective, data-driven, and culturally competent. This is achieved through our company-wide, systematic, and well coordinated QM Program that involves input from and coordination with all stakeholders including clients, members, providers, functional areas, and clinical staff. 3
4 Overview Each year, VBH-PA develops a comprehensive QM/UM Program Work Plan that includes a detailed set of goals and the actions necessary to achieve our goals. Measures of almost every aspect of our operation are developed and maintained. The collection of data for each measure is begun after a consistent data collection methodology has been established. This approach allows VBH-PA to track and trend progress towards achieving our goals. VBH-PA also prepares an annual QM Program Evaluation to assess the overall effectiveness of the QM Program, the strengths and accomplishments of the program, our performance across a set of clinical care and service quality initiatives, and adherence to HealthChoices standards. Based on the evaluation results, VBH-PA revises the QM Program Description annually to reflect the full scope of the Quality Program. In this 2014 Quality Management Program Summary, you will find information on our QM Program Evaluation results for 2014, as well as a description of our QM Program, including highlights of our QM Work Plan goals for
5 Quality Committees VBH-PA maintains a robust quality committee structure to aid in the oversight and implementation of its QM Program. We work in close partnership with our network participating providers, members/consumers, families, counties, oversight entities, and OMHSAS to continually improve the quality of care and services provided to our members. VBH-PA Quality Management has established Quality Management Committees (QMCs) for each Pennsylvania contract. Composition of the committees includes, at a minimum, the following representatives: Provider Representatives [Mental Health (MH) and Drug and Alcohol (D&A)] Consumer/Family Representatives County Representatives (at least one from each county) VBH-PA Clinical Representative VBH-PA QM Director and Quality Staff Department of Provider Relations Contractual Oversight Representative The Committees meet regularly throughout the year to review monitoring reports and updates on current activities underway. 5
6 2014 QM Program Evaluation: Data Monitoring As part of the Quality Management Program and Evaluation, we track our progress in meeting our goals. Some of the data VBH-PA monitors include: Utilization trends and patterns Risk management for critical incidents, complaints, and quality of care Preventative behavioral health services Evaluation of the quality effectiveness of internal processes Assessment of satisfaction from members and providers Evaluation of quality and performance of the provider network Coordination with primary healthcare Status updates on state-wide performance improvement projects 6
7 QM/UM Plan Highlights Member Satisfaction VBH-PA assesses member satisfaction through Consumer/Family Satisfaction Team surveys and also through an independent telephonic survey through Fact Finders, Inc. In 2014, overall member satisfaction with VBH-PA was rated 96% from over Provider Satisfaction 6,000 CFST surveys and 97% from 1,000 member Fact Finders surveys VBH-PA contracts with Fact Finders, Inc. to survey providers annually and utilizes the feedback to monitor our performance and identify potential areas for improvement in provider satisfaction. In 2014, overall provider satisfaction with VBH-PA was 96% 7
8 Access to and Availability of Care VBH-PA evaluates members access to behavioral health services and care through provider capacity reporting, geo access, member satisfaction, call monitoring, and exception waivers. Our performance standard for emergent care is one hour, urgent care within 24 hours, and routine care within seven days for most services. We answered our 800 numbers for 17,391 member calls with an average speed of 15 seconds We responded to 58,532 calls on our provider lines with an average speed of answer of 29.5 seconds 8
9 Denial and Appeals Decision Timelines VBH-PA maintains ongoing systems for tracking and monitoring compliance with applicable timelines for all levels of care managed. The 2014 results were as follows: Request Type VBH-PA Timeline for Resolution Percent Processed Timely Peer Review 1 Hr/24 Hrs 100% Grievance Level I 30 Days 100% GLI Resolution Letters 5 Days 99.7% Grievance Level II 30 Days 99.7% GLII Resolution Letters 5 Days 99.4% 9
10 2014 QM Program Evaluation: Monitoring Quality of Care 10
11 Monitoring Quality of Care Quality of care and service issues and trends are those that decrease the likelihood of desired health outcomes and that are inconsistent with current professional knowledge of behavioral health. VBH-PA has a defined procedure for the identification, investigation, resolution, and monitoring of behavioral health quality of care and service issues and trends including Critical Incidents, Quality of Care Committee Referrals, and Complaints. 11
12 Incident Reporting There are various types of events that qualify as critical incidents. More severe or high risk incidents meet criteria for adverse events and are investigated and presented to the Quality Management Committee for recommendations. All incidents are tracked and trended in the Quality Department. There were 1,492 reported critical incidents in Of these, 301 met adverse criteria for full investigation and resolution Adverse Incidents PHP 5% Case Management 4% Home Based 7% Other Residential 9% D&A 12% RTF 23% Inpatient / ER 14% Outpatient 26% 12
13 Performance Improvement Project Successful Transitions from Inpatient Care to Ambulatory Care A 3 year project ( ) of all Pennsylvania Medicaid BH MCOs that will focus on members hospitalized with a MH or SA diagnosis. The topic was selected by OMHSAS. The 4 performance measures are: Reducing behavioral health readmissions (30 Days) Reducing substance abuse readmissions (30 Days) Improving medication adherence to antipsychotic medications for individuals with schizophrenia Components of discharge management planning In 2014, VBH-PA submitted a written proposal which included a barrier analysis, proposed interventions, performance indicators, and a desktop procedure for conducting the onsite chart reviews of discharge planning. Selection of the Inpatient Providers for the onsite chart review process was also completed. 13
14 Quality Management Program Goals Each year, VBH-PA formulates a QM/UM Program Work Plan that includes goals and actions that are necessary to achieve those goals. Monitors of almost every aspect of our operation are developed and maintained. The following are highlights of VBH-PA program goals for 2015: Performance Improvement Project for readmissions and follow-up after hospitalization Risk Management for Quality of Care and Critical Incidents Investigation and resolution of member complaints Increase Coordination of Care Measure satisfaction with members and providers and target opportunities for improvement Treatment Outcomes Provider Profiling for Inpatient Mental Health, BHRS, and Independent Prescribers Enhance collaboration across PH and BH Identify internal improvement opportunities 14
15 Contact Us If you have any questions or are interested in more information about our Quality Management Program, please contact: VBH-PA Quality Department (TTY: ) Value Behavioral Health of Pennsylvania, Inc. 520 Pleasant Valley Road Trafford, PA
2014 Quality Management Program Behavioral Health Provider Summary
2014 Quality Management Program Behavioral Health Provider Summary Table of Contents MBHP Overview..... 3 Who We Are MBHP Vision MBHP Mission MBHP Values Quality Management Program......8 Overview Quality
More informationINTRODUCTION. QM Program Reporting Structure and Accountability
QUALITY MANAGEMENT PROGRAM INTRODUCTION To assure services are appropriately monitored and continuously improved, ValueOptions has developed and implemented a comprehensive (QMP). The QMP includes strategies
More informationVALUE BEHAVIORAL HEALTH OF PENNSYLVANIA (VBH-PA) IN PARTNERSHIP WITH FAYETTE COUNTY BEHAVIORAL HEALTH ADMINISTRATION HAVE ISSUED A
VALUE BEHAVIORAL HEALTH OF PENNSYLVANIA (VBH-PA) IN PARTNERSHIP WITH FAYETTE COUNTY BEHAVIORAL HEALTH ADMINISTRATION HAVE ISSUED A REQUEST FOR PROPOSALS (RFP) FOR SUBSTANCE ABUSE OUTPATIENT SERVICES SERVING
More informationREQUEST FOR SUBSTANCE ABUSE DRUG-FREE OUTPATIENT AND INTENSIVE OUTPATIENT SERVICES SERVING WASHINGTON COUNTY CHILDREN/ADOLESCENTS
VALUE BEHAVIORAL HEALTH OF PENNSYLVANIA (VBH-PA) IN PARTNERSHIP WITH THE WASHINGTON DRUG AND ALCOHOL COMMISSION, INC. HAVE ISSUED A REQUEST FOR PROPOSAL (RFP) REQUEST FOR SUBSTANCE ABUSE DRUG-FREE OUTPATIENT
More informationVALUE BEHAVIORAL HEALTH OF PENNSYLVANIA (VBH-PA) IN PARTNERSHIP WITH WESTMORELAND DRUG AND ALCOHOL COMMISSION REQUEST FOR PROPOSAL (RFP)
VALUE BEHAVIORAL HEALTH OF PENNSYLVANIA (VBH-PA) IN PARTNERSHIP WITH WESTMORELAND DRUG AND ALCOHOL COMMISSION REQUEST FOR PROPOSAL (RFP) FOR FUNDS SUPPORTING DEVELOPMENT OF A SUBSTANCE ABUSE TREATMENT
More informationJuly 15, 2015. Dear April Leonhard:
July 15, 2015 April Leonhard Department of Human Services Office of Long Term Living, Bureau of Policy and Regulatory Management P.O. Box 8025 Harrisburg, PA 17105-8025 Dear April Leonhard: Thank you for
More informationIndividual Therapies Group Therapies Family Interventions Structural Interventions Contingency Management Housing Interventions Rehabilitation
1980s Early studies focused on providing integrated treatment for individuals who have dual diagnosis (adding SA counseling to community MH treatment) Early studies also showed that clients did not readily
More informationReward for Quality Pilot Program
Reward for Quality Pilot Program TWO-YEAR OUTCOMES REPORT Magellan Behavioral Health of Pennsylvania Lehigh Valley Care Management Center Table of Contents Executive Summary... 2 Overview of Reward for
More informationOutcomes for People on Allegheny County Community Treatment Teams
Allegheny HealthChoices, Inc. Winter 2010 Outcomes for People on Allegheny County Community Treatment Teams Community Treatment Teams (CTTs) in Allegheny County work with people who have some of the most
More informationNORTH COUNTRY COMMUNITY MENTAL HEALTH NORTHERN AFFILIATION UTILIZATION MANAGEMENT PLAN November 1, 2001. Revised January 2013
NORTH COUNTRY COMMUNITY MENTAL HEALTH NORTHERN AFFILIATION UTILIZATION MANAGEMENT PLAN November 1, 2001 Revised January 2013 I. Mission II. III. IV. Scope Philosophy Authority V. Utilization Management
More informationRequirements For Provider Type 11 Mental Health/Substance Abuse Services
Requirements For Provider Type 11 Mental Health/Substance Abuse Services Specialty Code Please choose from the following for specialty and code: 113 - Partial Psychiatric Hospitalization (Children) 114
More informationProgram Plan for the Delivery of Treatment Services
Standardized Model for Delivery of Substance Use Services Attachment 5: Nebraska Registered Service Provider s Program Plan for the Delivery of Treatment Services Nebraska Registered Service Provider s
More informationFlorida Medicaid: Mental Health and Substance Abuse Services
Florida Medicaid: Mental Health and Substance Abuse Services Beth Kidder Assistant Deputy Secretary for Medicaid Operations Agency for Health Care Administration House Children, Families, and Seniors Subcommittee
More informationQuality Improvement Program Description
ABH 2013 Quality Improvement Program Description, Work Plan, and Evaluation 1 Appendix A Quality Improvement Program Description ABH 2013 Quality Improvement Program Description, Work Plan, and Evaluation
More informationPerformance Standards
Performance Standards Targeted Case Management Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best practice
More informationPerformance Standards
Performance Standards Residential Treatment Facility Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best
More informationQuality and Performance Improvement Program Description 2016
Quality and Performance Improvement Program Description 2016 Introduction and Purpose Contra Costa Health Plan (CCHP) is a federally qualified, state licensed, county sponsored Health Maintenance Organization
More informationQuality Management Plan Fiscal Year 2014 Version: 1
Quality Management Plan Fiscal Year 2014 Version: 1 Mental Health and Substance Abuse Division Community MHSA, Contractor Services Section Quality Management and Compliance Unit Table of Contents Introduction
More informationRiverside Physician Network Utilization Management
Subject: Program Riverside Physician Network Author: Candis Kliewer, RN Department: Product: Commercial, Senior Revised by: Linda McKevitt, RN Approved by: Effective Date January 1997 Revision Date 1/21/15
More informationPerformance Standards
Performance Standards Co-Occurring Disorder Competency Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best
More informationDBH/CBH defines, evaluates and reviews all aspects of the delivery of behavioral health services
5.1 Overview of the Quality Review Unit DBH/CBH defines, evaluates and reviews all aspects of the delivery of behavioral health services to each individual covered under HealthChoices for Philadelphia
More informationCT Behavioral Health Partnership
CT Behavioral Health Partnership October 8, 2014 Copyright 2014 ValueOptions Connecticut. All rights reserved. CT Behavioral Health Partnership Overview 2006 - Partnership Formed Partnership between Dept
More informationVI. Substance Use Disorder Services
VI. Substance Use Disorder Services Background In Pennsylvania, administration of services for persons with substance use disorders (SUD) is shared by the Bureau of Drug and Alcohol Programs (BDAP) in
More informationBehavioral Health Rehabilitation Services: Brief Treatment Model
Behavioral Health Rehabilitation Services: Brief Treatment Model Presented by Allegheny HealthChoices, Inc. 444 Liberty Avenue, Pittsburgh, PA 15222 Phone: 412/325-1100 Fax 412/325-1111 April 2006 AHCI
More informationProject Objective: Integration of mental health and substance abuse with primary care services to ensure coordination of care for both services.
Domain 3 Projects 3.a.i Integration of Primary Care and Behavioral Health Services Project Objective: Integration of mental health and substance abuse with primary care services to ensure coordination
More informationProvider Training Series The Search for Compliance Annual Mandatory Training for all Providers
Provider Training Series The Search for Compliance Annual Mandatory Training for all Providers Melissa Hooks, Director of Program Integrity Annual Training for All Providers Compliance with Medicaid Detection
More informationAetna Better Health Aetna Better Health Kids. Quality Management Utilization Management. 2013 Program Evaluation
Aetna Better Health Aetna Better Health Kids Quality Management Utilization Management 2013 Program Evaluation EXECUTIVE SUMMARY Introduction Aetna Better Health implemented its Medicaid Physical Health-Managed
More informationATTACHMENT D BLENDED CASE MANAGEMENT GUIDELINES
ATTACHMENT D BLENDED CASE MANAGEMENT GUIDELINES These guidelines establish the standards for the provision of mental health Blended Case Management (BCM) under provisions of the approved Medicaid State
More informationRehab and Recovery in Allegheny County
September 2013 Rehab and Recovery in Allegheny County Allegheny HealthChoices, Inc. (AHCI) is an innovative non-profit agency dedicated to supporting the provision of high-quality mental health and substance
More informationScioto Paint Valley Mental Health Center. Quality. Assurance Plan
Scioto Paint Valley Mental Health Center Quality 2015 Assurance Plan SCIOTO PAINT VALLEY MENTAL HEALTH CENTER QUALITY ASSURANCE PLAN OVERVIEW This document presents the comprehensive and systematic plan
More informationBehavioral Health Provider Training: Program Overview & Helpful Information
Behavioral Health Provider Training: Program Overview & Helpful Information Overview The Passport Behavioral Health Program provides members with access to a full continuum of recovery and resiliency focused
More informationMichigan Engagement Center
Michigan Engagement Center Quality Improvement Activities Provider Key Updates The ValueOptions Michigan Engagement Center is committed to being a center for excellence in developing and coordinating quality
More informationUnderstanding Behavioral Health Readmissions. Summary of the work of the Western Regional Behavioral Health Organization (WRBHO)
Finger Lakes Health Systems Agency Understanding Behavioral Health Readmissions Summary of the work of the Western Regional Behavioral Health Organization (WRBHO) Regional Commission on Community Health
More informationIdaho Health Home State Plan Amendment Matrix: Summary Overview. Overview of Approved Health Home SPAs
Idaho Health Home State Plan Amendment Matrix: Summary Overview This matrix outlines key program design features from health home State Plan Amendments (SPAs) approved by the Centers for Medicare & Medicaid
More informationPerformance Standards
Performance Standards Outpatient Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward best practice performances,
More informationDIRECT CARE CLINIC DASHBOARD INDICATORS SPECIFICATIONS MANUAL Last Revised 11/20/10
DIRECT CARE CLINIC DASHBOARD INDICATORS SPECIFICATIONS MANUAL Last Revised 11/20/10 1. ACT Fidelity 2. ISP Current 3. ISP Quality 4. Recipient Satisfaction 5. Staffing Physician 6. Staffing Case Manager
More informationUnderstanding Wraparound Services for Children in HealthChoices
Understanding Wraparound Services for Children in HealthChoices Everyone on Medical Assistance (MA) has an ACCESS card. Most people on MA now receive mental health and drug & alcohol services from a Behavioral
More informationA. IEHP Quality Management Program Description
A. IEHP Quality Management Program Description A. Purpose: The purpose of the QM Program is to provide operational direction necessary to monitor and evaluate the quality and appropriateness of care, identify
More informationFunctions: The UM Program consists of the following components:
1.0 Introduction Alameda County Behavioral Health Care Services (ACBHCS) includes a Utilization Management (UM) Program and Behavioral Health Managed Care Plan (MCP). They are dedicated to delivering cost
More informationGoal Statement To administer and manage contracted services to eligible persons in need of health care services to promote health maintenance.
HEALTH SERVICES To administer and manage contracted services to eligible persons in need of health care services to promote health maintenance. Number of medical encounters provided in the urgent care
More informationData Analysis and Review of the. Lehigh County. Consumer/ Family Satisfaction Team Report
Data Analysis and Review of the Lehigh County Consumer/ Family Team Report The Lehigh County Consumer/Family Team Report Overview The Recovery Partnership Consumer/Family Team works with Magellan. They
More informationPerformance Standards
Performance Standards Psychiatric Rehabilitation Clubhouse Performance Standards are intended to provide a foundation and serve as a tool to promote continuous quality improvement and progression toward
More informationRequirements For Provider Type 21 Case Manager
Requirements For Provider Type 21 Case Manager Specialty Code Please choose from the following list for the specialty and code: 076- Peer Support Services 211- Medical Assistance Case Management for HIV
More informationManual for Community Care Network Providers
Manual for Community Care Network Providers Community Care Behavioral Health Organization 339 Sixth Avenue Suite 1300 Pittsburgh, PA 15222 Provider Line: 1-888-251-CCBH (2224) Website: www.ccbh.com CHAPTER
More informationWashington Common Measure Set on Healthcare Quality. Behavioral Health Measure Selection Workgroup Meeting #2 September 14, 2015
Washington Common Measure Set on Healthcare Quality Behavioral Health Measure Selection Workgroup Meeting #2 September 14, 2015 Today s Meeting Agenda 1. Welcome, Member Introductions 2. Review: Public
More informationOFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN
OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN ISSUE DATE: EFFECTIVE DATE: NUMBER: January 1, 2010 January 1, 2010 OMHSAS-09-07 SUBJECT: BY: Peer Support Services - Revised Joan L. Erney,
More informationSubstance Abuse Treatment Record Review Presentation
Substance Abuse Treatment Record Review Presentation January 15, 2015 Presented by Melissa Reagan, M.S.W., L.S.W., Quality Management Specialist & Rebecca Rager, M.S.W., Quality Management Specialist Please
More informationHOW TO APPLY AND PREPARE FOR LICENSURE TO OPERATE A SUBSTANCE ABUSE PROGRAM IN MICHIGAN Authority: P.A. 368 of 1978, as amended
LARA/SUB-501 (5/13) Michigan Department of Licensing and Regulatory Affairs Bureau of Health Care Services Health Facilities Division Substance Abuse Program P.O. Box 30664 Lansing, MI 48909 PHONE: (517)
More information12 & 12, INC. FY 15 ANNUAL MANAGEMENT REPORT
12 & 12, INC. FY 15 ANNUAL MANAGEMENT REPORT 12 & 12 Inc. is a comprehensive addiction recovery treatment center serving individuals and their families who are affected by alcoholism and other drug addictions.
More informationCommunity Residential Rehabilitation Host Home. VBH-PA Practice Standards
Community Residential Rehabilitation Host Home VBH-PA Practice Standards Community Residential Rehabilitation (CRR) Host Homes are child treatment programs that are licensed under Chapters 5310, 3860 and
More informationBehavioral Health Quality Standards for Providers
Behavioral Health Quality Standards for Providers TABLE OF CONTENTS I. Behavioral Health Quality Standards Access Standards A. Access Standards B. After-Hours C. Continuity and Coordination of Care 1.
More informationNew York State Behavioral Health Organizations 2012 Summary. NYS Offices of Mental Health and Alcoholism and Substance Abuse Services
New York State Behavioral Health Organizations 2012 Summary NYS Offices of Mental Health and Alcoholism and Substance Abuse Services Phase 1 BHOs: Administrative Services Organizations Charge to BHOs:
More informationDepartment Of Human Services. Medical Assistance Transportation Program. Request for Information (RFI)
Department Of Human Services Medical Assistance Transportation Program Request for Information (RFI) Date: October 21, 2015 Table of Contents PART 1: GENERAL INFORMATION... 3 1.1 Purpose of this Request
More informationIntensive Outpatient Program (IOP) Clinical Documentation Training. February 2013
Intensive Outpatient Program (IOP) Clinical Documentation Training February 2013 Training Objectives APS Healthcare Introduction Utilization Review Process Overview of Medical Necessity Clinical Documentation
More informationThe Maryland Public Behavioral Health System
The Maryland Public Behavioral Health System Arleen Rogan, Ph.D. Division Director, Integrated Health Services Family Services, Inc. Arleen.rogan@fs-inc.org Behavioral Health includes: Mental health conditions
More informationPERFORMANCE STANDARDS DRUG AND ALCOHOL PARTIAL HOSPITALIZATION PROGRAM. Final Updated 04/17/03
PERFORMANCE STANDARDS DRUG AND ALCOHOL PARTIAL HOSPITALIZATION PROGRAM Final Updated 04/17/03 Community Care is committed to developing performance standards for specific levels of care in an effort to
More informationPOLICY #1571.00 SUBJECT: INPATIENT CERTIFICATION AND AUTHORIZATION
Effective Date: 9/13/2007; 7/13/2005 Revised Date: 11/7/07 Review Date: North Sound Mental Health Administration Section 1500 Clinical: Inpatient Certification and Authorization Authorizing Source: WAC
More informationTable 1 Performance Measures. Quality Monitoring P4P Yr1 Yr2 Yr3. Specification Source. # Category Performance Measure
Table 1 Performance Measures # Category Performance Measure 1 Behavioral Health Risk Assessment and Follow-up 1) Behavioral Screening/ Assessment within 60 days of enrollment New Enrollees who completed
More informationProvider Handbook Supplement for Blue Shield of California (BSC)
Magellan Healthcare, Inc. * Provider Handbook Supplement for Blue Shield of California (BSC) *In California, Magellan does business as Human Affairs International of California, Inc. and/or Magellan Health
More informationWelcome to Magellan Complete Care
Magellan Complete Care of Florida Provider Newsletter Welcome to Magellan Complete Care On behalf of Magellan Complete Care of Florida, thank you for your continued support and collaboration. As the only
More informationHEALTHCHOICES BEHAVIORAL HEALTH PERFORMANCE-BASED CONTRACTING REPORT 2011 COMMONWEALTH OF PENNSYLVANIA MARCH 20, 2012
PERFORMANCE-BASED CONTRACTING REPORT 2011 MARCH 20, 2012 CONTENTS 1. Stakeholder introduction... 1 2. Executive summary... 5 3. Access performance indicators... 7 4. Quality of process performance indicators...
More informationHistory of Secondary Student Assistance Programs in Pennsylvania
History of Secondary Student Assistance Programs in Pennsylvania Commonwealth SAP Interagency Committee November 2004 www.pde.state.pa.us EARLY PROGRAM DEVELOPMENT: In 1984, the Pennsylvania Department
More informationQuality Management. Substance Abuse Outpatient Care Services Service Delivery Model. Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA)
Quality Management Substance Abuse Outpatient Care Services Broward County/Fort Lauderdale Eligible Metropolitan Area (EMA) The creation of this public document is fully funded by a federal Ryan White
More informationSearch for Compliance Documentation Requirements Part 1: Consent Forms and Treatment Plans. Melissa S. Hooks Director of Program Integrity
Search for Compliance Documentation Requirements Part 1: Consent Forms and Treatment Plans Melissa S. Hooks Director of Program Integrity Overview of Presentation Background of Compliance Importance of
More informationBlue Choice PPO SM Behavioral Health Services (Mental Health & Chemical Dependency)
SM (Mental Health & Chemical Dependency) In this Section The following topics are covered in this section: Topic Page Integrated Program I 2 Program Components I 2 Focused Outpatient Management Program
More informationProvider Evaluation of Performance. Plan. Tennessee
Provider Evaluation of Performance Plan Tennessee 2015 Executive Summary UnitedHealthcare Community Plan is committed to ensuring the services members receive from network providers meet the requirements
More informationOhio s Community Behavioral Health Center Health Homes: A New Service Delivery Model
Ohio s Community Behavioral Health Center Health Homes: A New Service Delivery Model 1 C E N T E R F O R E V I D E N C E - B A S E D P R A C T I C E S A T C A S E W E S T E R N R E S E R V E U N I V E
More informationCHAPTER 59A-23 WORKERS COMPENSATION MANAGED CARE ARRANGEMENTS 59A-23.001 Scope. 59A-23.002 Definitions. 59A-23.003 Authorization Procedures.
CHAPTER 59A-23 WORKERS COMPENSATION MANAGED CARE ARRANGEMENTS 59A-23.001 Scope. 59A-23.002 Definitions. 59A-23.003 Authorization Procedures. 59A-23.004 Quality Assurance. 59A-23.005 Medical Records and
More informationMedicaid Managed Care Organization
Medicaid Managed Care Organization Systems Performance Review Statewide Executive Summary Final Report for Submitted by: August 2012 HealthChoice and Acute Care Administration Division of HealthChoice
More informationPOLICIES AND PROCEDURES
Policy: Eastpointe Local Management Entity / Managed Care Organization (LME/MCO) shall develop and maintain a contract network of quality behavioral healthcare service providers based on consumer and community
More informationHealthCare Partners of Nevada. Heart Failure
HealthCare Partners of Nevada Heart Failure Disease Management Program 2010 HF DISEASE MANAGEMENT PROGRAM The HealthCare Partners of Nevada (HCPNV) offers a Disease Management program for members with
More informationMAGELLAN HEALTH SERVICES ORGANIZATION SITE - SITE REVIEW PACKET 2011. Behavioral Health Intervention Services (BHIS) ONLY
MAGELLAN HEALTH SERVICES ORGANIZATION SITE - SITE REVIEW PACKET 2011 Behavioral Health Intervention Services (BHIS) ONLY Proprietary: Magellan Health Services policies apply to all subsidiaries,including
More informationAlcohol and Drug Treatment Beds by a Non- State Entity. HHS LOC Mental Health Subcommittee. February 24, 2013
Alcohol and Drug Treatment Beds by a Non- State Entity HHS LOC Mental Health Subcommittee February 24, 2013 Billy R. West, Jr., MSW, LCSW Executive Director About DAYMARK Our Mission: Daymark Recovery
More informationHow are Health Home Services Provided to the Medically Needy?
Id: NEW YORK State: New York Health Home Services Effective Date- January 1, 2012 SPA includes both Categorically Needy and Medically Needy Beneficiaries- check box 3.1 - A: Categorically Needy View Attachment
More informationOPTUM By United Behavioral Health OPTUM GUIDELINE EVIDENCE BASE: Level of Care Guidelines
OPTUM By United Behavioral Health OPTUM GUIDELINE EVIDENCE BASE: Level of Care Guidelines Guideline Evaluation and Treatment Planning Discharge Planning Admission Criteria Continued Stay Criteria Discharge
More informationMaryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland As of July 2003, 638,662 people were covered under Maryland's Medicaid/SCHIP programs. There were 525,080 enrolled in the Medicaid
More informationURAC Issue Brief: Best Practices in Network Management
1220 L Street, NW, Suite 400 Washington, DC 20005 202.216.9010 Best Practices in Network Management Introduction As consumers enroll in health plans through newly formed Health Insurance Marketplaces,
More informationSTRUCTURED OUTPATIENT ADDICTION PROGRAM (SOAP)
STRUCTURED OUTPATIENT ADDICTION PROGRAM (SOAP) Providers contracted for this level of care or service will be expected to comply with all requirements of these service-specific performance specifications.
More informationQuality Management Strategy
Quality Management Strategy Participant Access: An assessment to determine eligibility is conducted by participating Acquired Brain Injury waiver (ABI) providers utilizing the Medicaid Waiver Assessment
More informationProvider Profiling. Residential Treatment Facilities. 01/01/12 to 12/31/12
Provider Profiling Residential Treatment Facilities 01/01/12 to 12/31/12 1 Residential Treatment Facilities CBHNP utilizes a provider profiling process that is an important provider-level quality improvement
More informationCHAPTER FIFTY-EIGHT SUBSTANCE ABUSE TREATMENT PLAN. Purpose... 58:1. Discussion... 58:1. Definitions... 58:1. Policy and Procedure...
CHAPTER FIFTY-EIGHT SUBSTANCE ABUSE TREATMENT PLAN Purpose... 58:1 Discussion... 58:1 Definitions... 58:1 Policy and Procedure... 58:1 Referral for Evaluation... 58:1 Entering a Substance Abuse Treatment
More informationEHR for Behavioral Health. BH Encounter Documentation in EHR
EHR for Behavioral Health Developed by: Wendy Wisdom, MSW RPMS Behavioral Health System OIT Federal Lead, CAC Peter Stuart, MD Medical Director for Sonoma County Indian Health Project 2 Learning Objectives
More informationNursing Home to Community Program: A Discharge Planning Manual
Nursing Home to Community Program: A Discharge Planning Manual March 2006 Portions of this Manual may be cited on condition that proper credit is given to: Broome County Community Alternative Systems Agency
More informationOFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN
OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN ISSUE DATE March 18, 2014 EFFECTIVE DATE: March 18, 2014 NUMBER: OMHSAS-14-01 SUBJECT: BY: OMHSAS Guidelines for the Approval of Telepsych
More informationBlue Cross Blue Shield of Louisiana: Blue Value 500 with Rehab Summary of Benefits and Coverage: What this Plan Covers & What it Costs
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.bcbsla.com or by calling 1-800-599-2583. Important Questions
More informationCoventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Quality Management Program 2012 Overview Quality Improvement
More informationCARE MANAGEMENT PROGRAM AND PLAN
CARE MANAGEMENT PROGRAM AND PLAN 2015 INTRODUCTION... 2 PURPOSE... 3 SCOPE... 3 CARE MANAGEMENT... 3 CARE MANAGEMENT PRINCIPLES... 4 TRSN CARE MANAGEMENT PROGRAM... 4 CARE MANAGEMENT PROGRAM STRUCTURE...
More informationA Review of the Beacon Health Options Clinical Case Management
Clinical 3.50 CASE MANAGEMENT 3.504 Intensive Case Management (Child/Adolescent) Description of Services: Intensive Case Management provides for a single point of coordination/accountability in managing
More informationCenter for Health Care Strategies, Inc. Utilization Management Considerations for Care Management Entities
CHCS Center for Health Care Strategies, Inc. Utilization Management Considerations for Care Management Entities Technical Assistance Brief June 2013 A number of states and regions have begun to demonstrate
More informationPENINSULA REGIONAL SUPPORT NETWORK Utilization Management Plan FY 2015-2016
PENINSULA REGIONAL SUPPORT NETWORK Utilization Management Plan FY 2015-2016 Peninsula RSN Policies and Procedures The Peninsula Regional Support Network (PRSN) Utilization Management (UM) Plan summarizes
More informationOFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN
OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN ISSUE DATE April 15, 2015 EFFECTIVE DATE: April 1, 2015 NUMBER: OMHSAS-15-01 SUBJECT: BY: Community Incident Management & Reporting System
More informationSUBJECT: QUALITY MANAGEMENT OF THE NORTH SOUND MENTAL HEALTH ADMINSTRATION
Effective Date: Revised Date: Review Date: North Sound Mental Health Administration Section 5500 Quality Management: Quality Management of the North Sound Mental Health Administration Authorizing Source:
More informationOFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN
OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES BULLETIN ISSUE DATE: EFFECTIVE DATE: NUMBER: June 15, 2009 June 15, 2009 OMHSAS-09-04 SUBJECT: Best Practice Guidelines for Family Involvement with
More informationAnnual Notice of Changes for 2016
Healthy Advantage Plus HMO offered by Molina Healthcare of Utah Annual Notice of Changes for 2016 You are currently enrolled as a member of Healthy Advantage Plus HMO. Next year, there will be some changes
More informationPennsylvania Olmstead Plan. York & Adams Counties. Wernersville Service Area
Pennsylvania Olmstead Plan York & Adams Counties Wernersville Service Area July 2012 I. Introduction Following the release of the Department of Public Welfare s Office of Mental Health and Substance Abuse
More informationTIMEFRAME STANDARDS FOR UTILIZATION MANAGEMENT (UM) INITIAL DECISIONS
ADMINISTRATIVE POLICY TIMEFRAME STANDARDS FOR UTILIZATION MANAGEMENT (UM) INITIAL DECISIONS Policy Number: ADMINISTRATIVE 088.15 T0 Effective Date: November 1, 2015 Table of Contents APPLICABLE LINES OF
More information2014 Behavioral Health. Utilization Management. Program Description
APS Healthcare 2014 Behavioral Health Utilization Management Program Description 2014 APS BH UM Program Description APS Healthcare 2014 Behavioral Health Utilization Management Program Description I. PURPOSE
More informationQUALITY IMPROVEMENT PLAN AND PROGRAM DESCRIPTION 2014-2015
QUALITY IMPROVEMENT PLAN AND PROGRAM DESCRIPTION 2014-2015 REVISED AUGUST 12,2014 TABLE OF CONTENTS Organizational Overview.... 3 Mission.... 3 Executive Summary. 3 Race/Ethnicity of Service Area.....
More informationSENIOR MENTAL HEALTH COUNSELOR I/II
SENIOR MENTAL HEALTH COUNSELOR I/II DEFINITION To perform a variety of complex professional duties in the provision of outpatient and crisis mental health services to individuals and groups. DISTINGUISHING
More information