Behavioral Health Quality Management
If your life is in danger, or you need to report an emergency situation, call 9-1-1.
A telephone call can bring help in a crisis. For at-risk children and/or adults in emergencies and crises situations, a special 24-hour, 7-day a week, response program is available by calling one of the following phone numbers:
WHAT IS BEHAVIORAL HEALTH QUALITY MANAGEMENT?
Quality Management works closely with programs across Placer County’s System of Care (SOC) and various substance use and mental health service providers for quality assurance oversight and to ensure compliance with state and federal regulations. The department collaborates with and provides support to various community programs that service Placer County residents impacted by substance use and/or mental health disorders. The Behavioral Health Managed Care Unit authorizes and credentials Network Providers in the community to provide these services.
Quality Improvement (QI) activities include quality improvements and monitoring of: timely access, performance improvement projects, grievance outcomes, cultural and linguistic competence standards, beneficiary satisfaction with mental health services, and other information. Regulation requires that County Mental Health Plans (MHPs) establish a QI Committee in accordance with the contract between the MHP and the Department of Health Care Services (DHCS).
The QI Committee is composed of Placer/Sierra County staff, providers, and other stakeholders who meet quarterly. During the meeting, the QI Committee prepare and report on their quality improvement goals and plans. The QI Committee reviews and evaluates the results of QI activities and data trends; ensures follow-up of QI processes; institutes needed QI actions; and recommends policy decisions. Committee members discuss, make recommendations, and explore creative solutions to support each other. The QI program emphasizes family-centered and community-based services, promotes best practices, and supports culturally relevant services. It confirms that minimum standards of care are met, which are consistent with State and Federal requirements. To become part of the committee please contact [email protected].
Placer County has created a compliance plan and committee that promotes the highest standards of ethics and compliance. Through policies, procedures, and trainings, Placer County employees as well as our Mental Health and DMC-ODS providers maintain effective, efficient, and culturally sensitive community-based services for children and adults receiving services with Placer County.
Network Provider trainings are accessed via Placer Learns.
SAMPLES OF HANDOUTS YOU MAY FIND USEFUL:
- Attachment 1 ICD-10 Diagnosis Form (PDF)[SD2]
- Attachment 2 Intervention Starters (PDF)
- Attachment 3 Well Written Progress Notes (PDF)
- Attachment 4 Recoupments 2015 Medi-Cal Oversight Audit (PDF)
- CMS-1500 (PDF) Medi-Cal Billing Form
ANNUAL QI WORK PLAN AND EFFECTIVENESS PLAN
QI Work Plan FY 2020/2021
QI Effectiveness Plan FY 2020/2021
QI Work Plan FY 2019/2020
QI Work Plan FY 2018/2019
QI Effectiveness Plan FY 2018/2019
QI Work Plan FY 2017/2018
QI Effectiveness Plan FY 2017/2018
QI Work Plan FY 2016/2017
QI Effectiveness Plan FY 2016/2017
QI Work Plan FY 2015/2016
QI Effectiveness Plan FY 2015/2016
QI Effectiveness Plan FY 2014/2015
COMPLIANCE PLANS AND DOCUMENTATION
The Department of Health Care Services (DHCS) is responsible to ensure Placer County is following all policy and procedures mandated by State and Federal regulations by auditing Placer County.
In addition, Placer County Mental Health Plan (MHP) and Drug Medi-Cal Organized Delivery System (DMC-ODS) has the authority and responsibility to promptly investigate all grievances and monitor all work performed within the MHP and DMC-ODS, to make sure all applicable State and Federal regulations are met, and quality care is afforded to our clients. To do this we audit our providers every year.
WHAT A PROVIDER CAN EXPECT DURING AN ANNUAL AUDIT
A provider will receive an annual audit and will usually receive a letter 3-4 weeks before their scheduled audit date however no notification is required. They letter will contain information about the audit, what materials and client charts will be audited, and who will be the lead auditor. During an audit, the auditor will be looking at some or all the below elements (other items may be audited to comply with State and Federal regulations).
- Charting standards
- Treatment Plan
- Progress Notes
- For Substance Use that all ODS and NTP requirements are in chart
- Policies requested
- Personnel files
- Posted materials for patients’ rights and signed attestation
- Facility inspection
- Handicapped access
- Fire certificates
- Site licenses
WHAT IS A CAP AND WHAT TO DO IF I GET ONE?
A CAP or Corrective Action Plan is a way for Placer County to submit to you some of the deficiencies that were seen during your chart or site audit. In response to the CAP, you will be responsible for telling Placer County what changes you plan to make to fix the issues for future audits. This could be scheduling more training for staff or changing/updating a policy to correct the issue.
SITE CERTIFICATION/MEDI-CAL PROVIDER CERTIFICATION
To ensure that all Providers contracted with Placer County are meeting federal and state mandates, an initial site certification will be completed. A recertification is required every three years or as needed (provider moves or updates their facility). The site certification and onboarding process includes,
- National Plan and Provider Enumeration System (NPPES) set up- please ensure that your National Provider Identifier (NPI) and provider information are up to date and correct in NPPES for all three locations.
- Medi-Cal Provider Certification protocol.
- Fire clearance- required and part of the certification protocol.
- Staff credentialing prior to services delivery to comply with The Code of Federal Regulations (CFR), Title 42, Section 438.214.
- Staff Medi-Cal Enrollment: Licensed staff are required to enroll in the Medi-Cal program via the PAVE Provider Portal using the ORP application, as regulated by the Federal Cures Act.
- Staff to be setup with Placer Learns for annual trainings and other relevant trainings offered throughout the year.
- Exclusion Monitoring which is required, under federal law, to run all employees through federal exclusion databases. This is for initial and ongoing monthly checks against the required exclusion lists and licensure boards.
- Fiscal & Program Onboarding.