Risk & Quality Management Team
Ret: % of Medicaid Managed Care Standards with a completed risk assessment (cumulative)
Current Value
55.6%
Definition
Notes on Methodology
Sets of standards and Regulatory Compliance Committee (RCC) presentation date:
1. QAPI: 02/23/22
2. Coordination and Continuity of Care: 06/28/22
3. Coverage & Authorization of Services: 06/28/22
4. Grievances: 11/29/22
5. Appeals & Fair Hearings: 11/29/22
6. Availability of Services: 01/03/23
7. Furnishing of Services: 01/03/23
8. Provider Selection: 02/28/23
9. Credentialing & Re-Credentialing: 02/28/23
10. Enrollment and Disenrollment Requirements: 02/28/23
Story Behind the Curve
This measure is important because it demonstrates DVHA’s proactive approach to assessing all Medicaid managed care program related risk.
Staff from the Quality Improvement, Compliance and Oversight & Monitoring Units launched a comprehensive risk assessment initiative in the fall of 2021. The team’s process is to research the federal Medicaid managed care regulations, interview subject matter experts, identify potential risks, present recommendations to DVHA’s Regulatory Compliance Committee and track any approved interventions.
The growing trend line above demonstrates the team’s commitment to this project. Progress each quarter isn’t necessarily consistent, as standards differ in length and complexity. The team’s goal is to have completed an initial review of all standards by December 2023.
Narrative last updated 04/07/23
Partners
- DVHA’s Regulatory Compliance Committee
- Subject matter experts across DVHA and AHS
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