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 Habilitation Supports Waiver Review

MDHHS completes this review to ensure the PIHPs are meeting the service delivery requirements for the 1915(c) waivers and to provide an opportunity for training and consultation.  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. 

Summary of the findings for Full Review FY18:

  • Administrative Procedures (4 elements reviewed):  Full Compliance in 3 out of 5 (60%)
  • Freedom of Choice (2 elements reviewed): Full Compliance in 2 out of 2 (100%)
  • Implementation of Person Centered Planning (7 elements reviewed):  Full Compliance in 7 out of 7 (100%)
  • Plan of Service and Documentation Requirements (3 elements reviewed): Full Compliance in 213 out of 228 files (94%)
  • Behavior Treatment Plans and Review Committees (2 elements reviewed): Full Compliance in 1 out of 2 (50%)
  • Staff Qualifications ( 4 elements reviewed):  Full Compliance for 178 providers out of 185 (96%) for meeting credentialing standards; Full Compliance for 1093 out of 1,124 (97%) for non-licensed providers meeting qualifications; and Full Compliance for 1,112 out of 1,124 (99%) for providers meeting training requirements. 
  • Home Visits/Training/Interviews (9 home visits):    5 homes did not consistently complete incident reports as required. 

Summary of the findings for Follow Up Review FY19:

  • All Plans of Correction were found to be fully implemented and effective in correcting the findings
  • No additional findings for FY19

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.