“The mission of the Mental Health Division is to promote recovery and safety.”
Overview of EQRO Requirements for Validating Performance Measures for Mental Health Division and Regional Support Networks
March 24, 2004 Draft
- Federal (CMS) EQRO requirements related to Medicaid Managed
Care waivers go into effect for Washington State's publicly funded Mental
Health system this spring. The Mental Health Division is currently in the
contract procurement process to obtain External Quality Review services
for the state system. The website for these requirements is: http://www.hhs.gov/budget/07plan/sGoal3.html
- One of the four protocols required for Washington State
is the Validation of Performance Measures. The purpose of this protocol
is to:
- Evaluate the accuracy of Medicaid performance measures
reported by, or on behalf of an MCO/PIHP (as is done in Washington State);
and
- Determine the extent to which Medicaid-specific performance measures calculated by an MCO/PIHP followed specifications established by the State for the calculation of the performance measure(s).
- Evaluate the accuracy of Medicaid performance measures
reported by, or on behalf of an MCO/PIHP (as is done in Washington State);
and
- Because RSNs submit data to MHD-CIS where the data is
processed and passed to the MHD Research Group who do the actual calculations,
activities of RSNs, MHD-CIS and MHD-Research will be subject to EQRO review.
This will include an Information Systems Capacity Review at both the RSNs
and at MHD. A separate one-page overview of that protocol appears on the
back of this document. Much of the protocol activity addresses the validity
of performance measure numerators and denominators and calculations, and
EQRO scrutiny will be focused on the work of the MHD Research Group.
- The Mental Health Division, in conjunction with the Performance Data Work Group selected the following measures for EQRO validation (See the indicated page numbers in the July 2003 Performance Indicator Report for more detail and definitions).
- Penetration Rates: Medicaid Population (p. 22)
- Penetration Rates: State Hospital Inpatient per 1000 Population (p.40).
- Outpatient utilization: Medicaid Population Served (p. 50).
- Youth and Parents' Perception of Quality and Appropriateness (p. 76).
- Adults' Perception of Quality and Appropriateness (p.
78).
- Measures selected will require a focus on the validity
of enrollment, utilization, hospitalization and quality data.
- The Mental Health Division is currently working with CMS to clarify the application of this protocol to public behavioral health PIHPs and the reporting structure in Washington State.
