caleqro mh tools and protocols update v8 and trainings/2019 presentations and...saumitra sengupta...

Behavioral HealthConcepts, Inc.

CalEQRO Review Tools and Protocols Update FY 2019-20

Saumitra SenGupta and Gale Berkowitz

July 31, 2019

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We want to hear from you! Here’s how to submit comments and questions during the webinar.

• Please use the questions section.


Patrick Zarate

Meet the Team

Quality Reviewers

Information Systems Reviewers

Consumer/Family Member Consultants*

Admin/Operations

*CalEQRO acknowledges the contributions of other Consumer/Family Member Consultants who work with us on reviews

Saumitra SenGupta Gale Berkowitz Della Dash Cyndi Lancaster Lynda Hutchens Ewurama Shaw-Taylor Rob Walton Laysha Ostrow Harriet Markell

Rama Khalsa Tom Trabin Maureen Bauman Melissa Martin-Mollard Jan Tice

Bill Ullom Lisa FarrellLisa Farrell Judy Toomasson Bob Greenless

Marilyn Hillerman Tilda DeWolfe Walter Shwe Deb Strong

Mei Chung Kimberlee Cathey Rachel Phillips Desmond Kispert-Bostick

Caroline Yip Mark Refowitz Lamar Brandysky

Angela Kozak-Embrey Olivia Kozarev Laurence Smith

Dr. William Holcomb, CEO

Dr. Karen Baylor, COO


CalEQRO MHP Review ScheduleFY 2019-20

MHP On-site MHP On-site MHP On-site MHP On-siteGlenn 8/6/19 Kings 10/16/19 Merced 1/7/20-1/8/20 El Dorado 3/18/20

Butte 8/6/19-8/7/19 Stanislaus 10/22/19-10/23/19 San Diego 1/7/20-1/9/20 Santa Barbara 3/24/20-3/25/20

Colusa 8/8/19 San Joaquin 10/22/19-10/23/19 Santa Clara 1/14/20-1/16/20 Santa Cruz 3/24/20-3/25/20

Mariposa 8/13/19 Solano 10/29/19-10/30/19 Imperial 1/14/20-1/15/20 Plumas 4/15/20

Madera 8/15/19 Alameda 11/5/19-11/17/19 Marin 1/28/20-1/29/20 San Bernardino 4/21/20-4/23/20

Sacramento 8/27/19-8/29/19 Tehama 11/5/19 Placer/Sierra 1/28/20-1/29/20 San Mateo 4/22/20-4/23/20

Alpine 9/4/19 Calaveras 11/7/19 Contra Costa 2/4/20-2/6/20 Trinity 4/28/20

Tulare 9/4/19-9/5/19 Humboldt 11/13/19 Sutter/Yuba 2/11/20 Inyo 4/28/20

Mendocino 9/10/19-9/11/19 Orange 11/19/19-11/21/19 Yolo 2/11/20-2/12/20 Siskiyou 4/30/20

Amador 9/11/19 San Luis Obispo 12/3/19-12/4/19 Ventura 2/25/20-2/27/20 Mono 4/30/20

Shasta 9/17/19-9/18/19 San Francisco 12/3/19-12/5/19 Nevada 2/26/20 Modoc 5/5/20

Los Angeles 9/23/19-9/26/19 Napa 12/4/19 San Benito 3/4/20 Lassen 5/7/20

Monterey 10/1/19-10/2/19 Lake 12/4/19 Tuolumne 3/11/20 Del Norte 5/13/20

Kern 10/1/19-10/3/19 Sonoma 12/10/19-12/11/19 Fresno 3/17/20-3/19/20 Riverside 5/18/20-5/20/20

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CalEQRO MHP Review Stages – FY 2019-20Ø Development of Review Schedule: January - March 2019

Ø CalEQRO Team Assignments: March -July 2019

Ø Tools Revision: May – July 2019

Ø MHP Notification: 60-65 days prior to the on-site review

Ø MHP Document Submission: 30 days prior to the on-site review

Ø Review Agenda Planning

Ø CalEQRO Review of MHP Submissions

Ø On-Site Review: 1-4 days depending on MHP size starting from August 2019

Ø DHCS Review Draft: 30 days post on-site

Ø MHP Review Draft: 60 days post on-site

Ø MHP Final Report: Within 90 days post on-site5


We Heard You!

60% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

TA was helpful in meeting PIP requirements

Review sessions capture quality efforts

Satisfied with level of involvement

Notification materials were clear

Results from MHP Feedback Survey

Strongly Disagree Disagree Somewhat Disagree Neutral Somewhat Agree Agree Strongly Agree


Notification Materials

Notification letter

• New this year – Updated review document organization scheme to match the revised key components

Response to FY 2018-19 Recommendations

• New this year – Updated response sheet to match the FY 2018-19 recommendation domains

MHP Significant Changes and Strategic Initiatives

• New this year - Updated review document organization scheme to match the revised key components

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Documents to be Completed by the MHP prior to On-Site ReviewPIP Development Outline

• No change

MHP Assessment of Timely Access

• New this year – Timeliness standards are now aligned with DHCS standards

ISCA

• No significant change

• Three versions – MHP only, DMC only, MHP-DMC joint review

Katie A./Pathways to Well-Being

• No change at this time, may be revised during FY 2019-20

MHP Response to FY 2018-19 Recommendations

• Organized by domains 8


Response to Recommendations

Access Recommendations• <Access Recommendation 1>

o MHP Response• <Access Recommendation 2>

o MHP Response• <Access Recommendation 3>

o MHP Response

Timeliness Recommendations• <Timeliness Recommendation 1>

o MHP Response• <Timeliness Recommendation 2>

o MHP Response• <Timeliness Recommendation 3>

o MHP Response 9


Documents for MHP Reference

PIP Development Implementation & Submission Tool (www.caleqro.com )

• No Change

Key Components ( www.caleqro.com )

• Significantly Revised (see next slides)

Approved Claims Summaries – Overall, Foster Care, TAY, ACA, PM Tables (available on Box by invitation only)

CFM Focus Group Guidelines (see slide 14)

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http://www.caleqro.com/

http://www.caleqro.com/


Agenda Planningo <MHP> County MHP

o CalEQRO FY 2019-20 On-Site Review Agenda Unless otherwise noted, all conference rooms are located at MHP Administrative Office

at: <MHP NAME & FULL ADDRESS>

• <DATE>

Time DAY 1 - ACTIVITIES

8:30 AM – BHC REVIEWERS: , LEAD REVIEWER , I S R E V I E W E R , CFM CONSULTANT

Opening Session

Introduction to BHC and Review Team MHP Team Introductions Overview of review purpose and timelines Significant MHP Changes in Past Year Highlights of MHP Current Key Initiatives Response to Previous Year’s Recommendation SB 1291 (EPSDT POS data) Network Adequacy MHP Participants: Leadership, Quality Management Staff, Key Stakeholders

BHC Participants: All

Location:

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Question Break

Please submit your questions using the question box on the webinar

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Key Components (KCs)Formatting Upgrades

• Navigation Pane

• Embedded Item Hyperlinks

Additional Domains

• Aligned with the MHP Summary of Findings

Revised and Updated Individual Key Components

• Organization of sub-items

Change in Rating Scheme

• Item level partial rating

• Key Component level scoring 13


KCs – Formatting Upgrades

Navigation Pane Embedded Hyperlinks

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KCs – Additional DomainsIn FY 2018-19, CalEQRO significantly revised the MHP report template with a new Summary of Findings section.

In FY 2019-20, the Key Components have been better aligned with the Summary of Findings.

The existing domains have been revised:

• Access

• Timeliness

• Quality

Two new domains have been added:

• Beneficiary Progress/Outcomes

• Structure and Operations 15


KCs – Revised and UpdatedAs applicable, sub-items have been re-organized in the following sequence:

• The MHP has a plan, process, structure in place for the topic

• The MHP tracks and trends data

• The MHP regularly shares the findings with the appropriate stakeholders

• The MHP makes decisions based on the findings

• The MHP undertakes performance/quality improvement activities based on the findings, if needed

• The MHP tracks the effectiveness of its performance/quality improvement activities

Note: Not all items follow this structure, but this is what the reviewers are looking for in general.

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KCs – Change in Rating Scheme

Sub-item ratings have been changed from Yes-No to

• Present, Partially Present, Not Present

• These are assigned a score of 2, 1, and 0

For each KC, the sub-item scores are added up to create a more continuous rating scale.

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MHP Assessment of Timely Access (MATA)

Name changed from Timeliness Self-Assessment

First Offered Appointment – The standard is 10 business days

First Psychiatry Appointment – The standard is 15 business days

Urgent Appointment – Separated into two categories

• Those that do not require pre-authorization – The standard is 48 hours

• Those that require pre-authorization – The standard is 96 hoursNote – The MHPs are required to report for the entire system, not for just county operated or contract provider services.

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Source: DHCS MHSUDS Information Notice 18-011 on Network Adequacy


CFM Focus Group GuidelinesIn FY 2018-19, there was an increase in the number of focus groups where CalEQRO was unable to report on due a lack of adequate participants.

To encourage greater participation, we encourage the following:

• Collaborate with peer employees or programs to assist with planning the groups.

• Contact 12-16 individuals in order to ensure a focus group size of 10-12.

• Ensure location and times convenient to the target population.

• Mention that CalEQRO will provide a gift card to participants who stay until the end of the focus group.

• Inform participants of the independent nature of the EQR, that CalEQRO is not affiliated with the MHP.

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Other Items

PIP Development Outline – No change

ISCA – No significant change

SB 1291 – Looking for evidence that the MHP is tracking the performance measures available from the state

Network Adequacy – CalEQRO is awaiting the first round of data from the state for validation purposes

Quality Rating System – CalEQRO will assist DHCS in the development

CalEQRO Focus Group Questionnaires – These are being aligned with the KC domains. These are not publicly available

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Q & A

CalEQRO - https://caleqro.com/

Mental Health EQRO - https://caleqro.com/mh-eqro

MH EQRO Review Materials - https://caleqro.com/mh-eqro#!mh-

review_materials/MHP%20Notification%20Materials

Contact – [email protected] 21

https://caleqro.com/

https://caleqro.com/mh-eqro

https://caleqro.com/mh-eqro

mailto:[email protected]