Quality & Compliance

Quality

The Michigan Department of Health and Human Services requires that each PIHP have a Quality Assessment and Performance Improvement Program (QAPIP) that meets the standards based on the Guidelines for Internal Quality Assurance Programs, the Balanced Budget Act of 1997 (BBA), Public Law 105-33 and 42 Code of Federal Regulation (CFR) 438.359 of 2002. 

MSHN has a quality program that is in compliance with the Michigan standards by identifying 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.

Compliance

MSHN's  compliance program follows the requirements outlined in the 42 CFR 438.608 and ensures the following:

• Monitoring of activities for delegated functions.
• Written policies for all employees and contractors providing detailed information about the False Claims Act and other Federal and State laws described in section 1902(a)(68) of the Act.
• Program integrity administrative and management arrangements or procedures, including a mandatory compliance program that includes:
  • Written policies and procedures that describe how the PIHP will comply with Federal and State directives, with effective lines of communication to the PIHP’s employees. 
  • Effective training and education for the compliance officer, senior management, and the PIHP’s employees. 
  •  Provisions for internal monitoring and auditing to include post payment reviews of paid claims to verify that services were billed appropriately.