“The mission of the Mental Health Division is to promote recovery and safety.”
External Quality Review Organization
As required by federal law governing managed health care systems, the Washington State mental health system must have a qualified External Quality Review Organization review and report on the systems ability to meet federal requirements. Please see the federal regulations (CFRs) governing Medicaid managed care and EQRO activities.APS Healthcare has been awarded the contract by the Mental Health Division to do the external review of Washington's mental health care system. They will conduct all required EQRO activities with the exception of Encounter Data Validation, which will be conducted by Mental Health Division. See APS Healthcare's On-Site Review Schedule.
Our waiver requires several of these protocols. Others are optional and can be used by states as part of their individual Waivers. The State of Washington has chosen to implement only the three protocols required by CMS for all states, beginning in 2004. These are:
- Validating Performance Measures
Complete protocol at CMS website (
Document)
- Validating Performance Improvement Projects
Complete Protocol at CMS website (
In addition to these, as a specific condition of the Washington State Medicaid Waiver, the state will be required to conduct a Validation of Encounter Data. This activity will be conducted by the State in 2004.
The protocols for Validating Performance Measures and Encounter Data also require that the State and RSNs complete the INFORMATION SYSTEMS CAPABILITIES ASSESSMENT for MANAGED CARE ORGANIZATIONS and PREPAID HEALTH PLANS known as Appendix Z (One Page Summary).
The Mental Health Division has drafted a Word document that outlines the roles and responsibilities for the Division, RSNs, and EQRO.
Adobe Acrobat Reader is required to view PDF files and you can download it for free. If you do not have an application that can display Microsoft Word documents (.doc), you can download a free Word Viewer.
For more ways to get in touch with the Department of Mental Health Services, go to the DSHS Contact Information Web page. Mental Health Related Questions Contact:
