External Site Reviews

MSHN has external quality reviews completed by the Michigan Department of Health and Human Services (MDHHS) and the Health Services Advisory Group (HSAG).  To comply with requirements of the Center for Medicare and Medicaid Services (CMS), MDHHS completes a review of the PIHPs for services provided under the Habilitation Supports Waiver (HSW) and Substance Use Services.  Also to comply with CMS requirements, MDHHS contracts with HSAG to measure and report on performance to assess the quality and appropriateness of care and services provided to members. HSAG completes three separate reviews:  Performance Measure Validation (PMV), Performance Improvement Project (PIP) and the Compliance Monitoring review.  

HSAG Performance Measure Validation (PMV) Review

The purpose of Performance Measure Validation (PMV) review is to assess the accuracy of performance indicators reported by the PIHPs and to determine the extent to which performance indicators reported by the PIHPs follow state specifications and reporting requirements. 

HSAG Compliance Monitoring Review

The purpose of Compliance Monitoring review is to determine the PIHP’s compliance with the standards set forth in 42 CFR §438—Managed Care Subpart D and the quality assessment and performance improvement requirements described in 42 CFR §438.330. 

HSAG Performance Improvement Project

The purpose of the Performance Improvement Project review  is to comply with the MDHHS requirement that the PIHP conduct and submit performance improvement projects (PIPs) annually to comply with the Balanced Budget Act of 1997 (BBA), which states that the quality of health care delivered to Medicaid enrollees in PIHPs must be tracked, analyzed, and reported annually.  PIPs provide a structured method of assessing and improving the processes, and thereby the outcomes, of care for the population that a PIHP serves.

MDHHS Waiver Reviews

The Michigan Department of Health and Human Services (MDHHS) conducted an on-site review for our region from July 13, 2020 through August 21, 2020.  The purpose of the review was to provide monitoring on the service delivery requirements of the 1915 (c) waivers that include the Habilitation Supports Waiver (HSW), the Waiver for Children with Serious Emotional Disturbance (SEDW) and the Children’s Waiver Program (CWP).     

Due to the findings report containing protected health information, we are unable to post the report.  Therefore the following is a summary of the findings.  Each of the standards contained several elements that were reviewed and there were some deviation in the elements between each of the waiver reviews.

HSW: Habilitation Supports Waiver

CWP:  Children's Waiver Program

SEDW:  Serious Emotional Disturbance Waiver

N/A:  Not Applicable

 

Standard Reviewed:

HSW

CWP

SEDW

Administrative Procedures

100%

N/A

N/A

Administrative:  Environmental Modifications

80%

N/A

N/A

Claims coded in accordance with MDHHS policies

N/A

100%

N/A

Eligibility

N/A

100%

100%

Freedom of Choice

98%

100%

N/A

Implementation of Person-Centered Planning

89%

84%

76%

Plan of Service and Documentation Requirements

78%

89%

88%

Behavior Treatment Plans and Review Committees

69%

100%

100%

Health and Welfare (new section for 2020)

98%

100%

98%

Staff Qualifications (Licensed)

94%

97%

96%

Staff Qualifications (Non-Licensed)

74%

56%

38%

Health and Safety

N/A

N/A

N/A

Residential Home Visits/Trainings/Interviews

N/A

N/A

N/A

Non-Residential Home Visits

N/A

N/A

N/A

Note:  The percentages were calculated by dividing the total number of charts that received a score of “yes” (full compliance) by the total number of charts reviewed for each element and then averaging the percentages for all elements.

MSHN submitted a plan correction for each standard reviewed that did not receive full compliance.  MDHHS will be completing a follow up review during February/March of 2021.

 

MDHHS Substance Use Services Review

MDHHS completes this review to determine compliance with the Substance Use Agreement with the Centers for Medicare and Medicaid Services.  The purpose is to review compliance with established standards as well as serve as a quality improvement opportunity to provide technical assistance with the provision of SUD services.