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NC Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
 
 

Quality of Care

A Systematic Process for Assuring Quality Services

Webinar (6/11) Clarifies the guidelines and dataflow

Quality of Care

As a part of the utilization review process for Medicaid behavioral health services, the Division of Medical Assistance requires utilization review vendors to send information to DMA regarding cases with concerns about safety issues or complex cases.  The Division of Mental Health, Developmental Disabilities and Substance Abuse Services and the Division of Medical Assistance have updated this process by requiring vendors to submit data in a specified format. This data will be collected and analyzed by the Quality of Care Committee consisting of DMH/DD/SAS and DMA staff.

Resources

The following resources provide additional information about the Quality of Care process:

  • Quality of Care Guidelines– These guidelines describe how concerns identified by the state's Utilization Review vendors are communicated to and followed up by the appropriate LME.
  • Data Collection Form – This database is to be used by Utilization Review vendors and LMEs to provide data to DMH/DD/SAS and DMA.
  • Webinar (6/11) This webinar clarifies the guidelines and dataflow.
  • Quality of Care Data Collection Process Update(9/12/11) This PowerPoint presentation provides updated information regarding the guidelines, data flow and the independent assessment process.

Independent Assessment Guidelines

The Independent assessment process is a complementary process with the quality of care process.  Pursuant to Session Law 2010-31, Section 10.36, individuals who have been receiving a selected enhanced Medicaid service for an extensive length of time may be referred for an Independent Assessment in order to ensure appropriate service delivery continues and all identified needs are met. 

Independent Assessment Guidelines Resources

The following resources provide additional information about the Independent Assessment process:

  • Independent Assessment Guidelines These guidelines describe how individuals are selected for independent assessments and the LME responsibilities regarding the assessment.
  • Consumer Notification Template – This is a sample letter that must be provided to the individual who requires the independent assessment.
  • Audit Tool  When the LME is prompted by QOC committee to perform a chart review based upon either the independent assessment guidelines or in response to a Type III referral, the LME selects at random, a number of provider charts for review.  The LME utilizes this tool for the chart review. 

 

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