Newsletter February 2020

Quality & Compliance Update

Kim Zimmerman, MBA-HC, LBSW, CHC

Director of Quality, Compliance and Customer Service

Quality Assessment and Performance Improvement Program

The Michigan Department of Health and Human Services (MDHHS) requires each Pre-paid Inpatient Health Plan (PIHP) to have a Quality Assessment and Performance Improvement Program that meets the standards outlined in the Medicaid Managed Specialty Supports and Services Contract, Attachment P7.9.1: Quality Assessment and Performance Improvement Programs for Specialty Pre-paid Inpatient Health Plans. Mid-State Health Network (MSHN) as the PIHP is responsible for ensuring that the responsibilities of the Quality Management Program are outlined in the Quality Assessment and Performance Improvement Plan (QAPIP). The scope of MSHN’s QAPIP program is inclusive of all
Community Mental Health Service Programs (CMHSPs), the Substance Use Disorder (SUD) Providers and their respective provider networks.

Michigan standards state that the PIHP must have a written description of its QAPIP which specifies 1) an adequate organizational structure which allows for clear and appropriate administration and evaluation of the QAPIP; 2) the components and activities of the QAPIP; 3) the role for recipients of service in the QAPIP; and 4) the mechanisms or procedures to be used for adopting and communicating process and outcome improvement.

The QAPIP must be accountable to a Governing Body that is a PIHP Board of Directors. Responsibilities of the Governing Body for monitoring, evaluating, and making improvements to care include:

  1. Oversight of the QAPIP: There is documentation that the Governing Body has reviewed and approved the overall QAPIP and an annual Quality Improvement (QI) plan.
  2. QAPIP Progress Reports: The Governing Body routinely receives written reports from the QAPIP describing performance improvement projects, the actions taken and the results of those actions.
  3. Annual QAPIP Review: The Governing Body formally reviews on a periodic basis (but no less frequently than annually) a written report on the operation, implementation and effectiveness of the QAPIP. This includes ensuring effective systems exists for monitoring, evaluating and improving quality of care..
  4. The Governing Body submits the written annual report to MDHHS upon request. The report will include a list of the members of the Governing Body.

The QAPIP is reviewed annually against any changes in PIHP/MDHHS contract and changes/additions to
MSHN’s internal policies/procedures and practices. The QAPIP is reviewed and approved by the Quality
Improvement Council (QIC), MSHN Leadership, Operations Council and MSHN’s Board of Directors.

For further information, please contact Kim at Kim.Zimmerman@midstatehealthnetwork.org.

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