Overview of EQRO Requirements for Validating Performance Measures for Performance Improvement Projects (PIPs)

Federal (CMS) EQRO requirements related to Medicaid Managed Care waivers go into effect for Washington State's publicly funded Mental Health system this spring.
One of the four protocols required for Washington State is the Validation of Performance Improvement Projects. This protocol describes the activities that must be undertaken in validating Performance Improvement Projects of clinical and non-clinical health care services provided by MCOs and PIHPs as directed by the State.
The Mental Health Division, with Regional Support Networks input, selected two performance improvement projects to be implemented by all RSNs this year - one clinical (consumer participation in treatment) and one non-clinical (submission of HIPPA-compliant transactions).
The protocol specifies 10 steps to be followed in validating PIPs:
- Review the selected study topic(s)
- Review the study question(s)
- Review selected study indicator(s)
- Review the identified study population
- Review sampling methods (if sampling was used)
- Review the RSN’s data collection procedures
- Assess the RSN’s improvement strategies
- Review data analysis and interpretation of study results
- Assess the likelihood that reported improvement is "real"
- Assess whether RSN has sustained its documented improvement

Additional detail is provided in the protocol.

By end of first federal fiscal year (August 2004) RSNs should have implemented at least the two required Performance Improvement Projects. By end of second review year, RSNs should have initiated at least two additional Performance Improvement Projects.
The Mental Health Division is currently working with the Centers for Medicare and Medicaid Services to clarify the application of this protocol to public behavioral health PIHPs and the reporting structure in Washington State.