Medicaid Compliance Unit

Annual Medicaid compliance score from External Quality Review Organization (EQRO)

86%2019

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Partners
  • Department of Aging and Independent Living (DAIL)
  • Vermont Department of Health (VDH)
  • Department of Mental Health (DMH)
  • Department of Children and Families (DCF)
  • Agency of Human Services Central Office (AHS CO)
Story Behind the Curve

The External Quality Review Organization (EQRO) audit is conducted annually, but there are three different groups of standards. The audit focuses on one group of standards per year on a three year cycle. Some audit years have more difficult standards. Also, the auditors tend to raise the bar each year, challenging us to continue to improve our compliance. For example, if we received a 100% score one year and did nothing to improve our work, we might not necessarily get a 100% score again the next time the same standards are reviewed. The audit scores demonstrate not only our compliance with standards, but also our commitment to improving our compliance program.

The EQRO Compliance audit is conducted annually, but the topics rotate through a three-year cycle. When reviewing this data, it is helpful to consider these topic cycles. For example, 2014 and 2017 covered the same general topics and the data show that these topics (Provider Enrollment and Credentialing) have been a struggle for us. We will be audited on these standards again in 2020 and have made significant progress on improving our enrollment systems since 2017.

Last updated:  01/15/2020

Strategy

Close collaboration with our partners has been the most effective strategy for keeping our compliance scores high. The audit covers topics that go beyond DVHA’s direct responsibilities, so each standard requires cooperation from partnering departments and the AHS Central Office.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy