RESPONSIBILITIES GRID LRP responsibility or CMHSP responsibility FUNCTIONS

Transcription

1 LRP responsibility or CMHSP responsibility FUNCTIONS 1. Customer Services and Complaints process oversight. Includes the LRP appointing a dedicated Customer Services Lead person, providing an 800 number for the region, and developing procedures for carrying out the functions. 2. Tracking and analysis of complaints, grievances, appeals and other customer service problems. 3. Providing customers with current information regarding benefits, provider network, processes regarding access, service authorization, and grievance and appeal practices. 4. Documenting and monitoring performance standards related to effectiveness and efficiency in the area of complaints, grievances, appeals and customer services response. 5. Establish and maintain customer service operational policies and procedures. 6. Documentation requirements, including form and format, reporting requirements and time frames. 7. Record and report timely all second opinions, grievances, requests for hearing and disposition, denials, sentinel events, and critical incidents. 8. Critical incidents report monthly, 45 days after the end of the month in which the event occurred. Allowance for substantiating event. 9. Coordination of local customer service resources. 10. Consumer involvement oversight/regional policy and standard setting. 11. Ensure consistent communication and standardized message. 12. Provide consumer involvement options to engage consumers, and other stakeholders, including members of the general public, in decision oriented activities. Provide consumer choice in processes. 13. Orientation and training for consumers to participate in decision oriented activities. 14. Consumer satisfaction survey report (annual and required to LRP by July 31 st for current fiscal year) 15. Development and maintenance of written materials, including regional customer handbook and provider directory. 16. Information Dissemination (Privacy Notices, benefit plan information). 17. Establish and maintain central telephone number 18. Compliance with Customer Services requirements and following policies and procedures for region. 19. Grievance and Appeals oversight 20. Ensure that information is provided to recipients regarding grievance processes, procedures, and time frames. 21. Ensure providers under contract to CMHSP s receive grievance information at the time of entering a contract. 22. Ensure recipients receive reasonable assistance in completing forms and navigating processes (including use of interpreter and TTY/TTD). 23. Maintenance of a central log and record system for all grievance activity. 24. Acknowledge recipient of grievance to the beneficiary. 25. Submit written grievance to appropriate staff with authority to require corrective action. 26. Facilitate resolution of grievance within 60 days and forward a written disposition to the recipient, guardian or parent. 27. Offer second opinion/fair hearing process. 28. Compliance with Grievance requirements and following policies and procedures for region.

2 29. Marketing and Community Education 30. Enrollee Rights oversight. Ensure consistency with MDCH contractual and reporting requirements, and consistency with federal standards for enrollee grievances. 31. For Recipient Rights, the LRP will assure that each CMHSP/CA is substantially compliant with the MDCH audit. In addition, the LRP will report all RR data that is required regionally to be reported to MDCH. 32. Ensure CMHSP/CA notify recipients that oral interpretation and written information is available in prevalent languages. 33. Ensure that CMHSP/CA notify recipients that information is available in alternative formats. 34. Annual audit and/or review of Grievances and Appeals and Complaints processes. 35. Ensure Consumerism and Inclusion are supported in all service processes. 1. Utilization Management oversight. To provide leadership and guidance to the CMHSPs in the area of utilization management (UM). UM leadership may include but is not limited to: establishment and oversight of expectations and policies which will ensure compliance with state and industry standards, exploring methods to increase efficiencies and inter-rater reliability across the region, and most importantly to ensure that individuals are receiving the appropriate level of care based on medical necessity and evidenced based practice. The UM Oversight Committee (also UM advisory team) includes representation from each CMHSP. The framework to be utilized by this group will be in-line with the triple aim: population health, consumer experience, and cost effectiveness. When: On-going 2. Establish and maintain utilization management policies and procedures. Develop and disseminate high level UM policies and procedures which will allow for compliance with MDCH standards and cross regional efficiencies. When: Annual 3. Facilitate utilization management committee and its review processes. Establish a UM Oversight committee with representative from each CMHSP. The committee will meet at least monthly and will provide input and oversight in UM functions as identified as the responsibility of the LRP. The UM oversight committee will develop and follow a UM plan that is reviewed and revised annually. The UM Oversight Committee reviews and disseminates new policies, provides annual review of established policies and SSG s, collects UM data and provide adequate reporting to the state, and other tasks as identified during the development of the LRP. When: Monthly 4. Develop and maintain benefit plan and dissemination of Service Selection Guidelines. 5. Update Service Selection Guidelines based on federal and state changes/requirements and communicate changes. The LRP with input from UM Oversight Committee will review Service Selection Guidelines on an annual basis, revise as appropriate, and disseminate to CMHSPs. When: Annual 6. Monitor process of using Service Selection Guidelines as the standard for care delivery. When: Annual 7. Access to services oversight. Ensure that the services / levels of care defined in the SSG s are available to eligible individuals. When: Annual 8. Authorization for services based on Service Selection Guidelines oversight. Ensure that authorization of services is based on the criteria established in the SSG s. When: Annual

3 RESPONSIBILITIES GRID 9. Annual assessment of the adequacy of access to and availability of services. A yearly assessment to evaluate whether individuals are receiving timely and appropriate services. When: Annual 10. Determine and verify customer financial eligibility for benefit plan using Service Selection Guidelines. 11. Determine and verify customer clinical eligibility for services using Service Selection Guidelines. (Intensity of need/severity of Illness and level of care) 12. Request for service disposition process. (Referral, diversion, denial) 13. Initial authorization/denial of services for benefit plan using Service Selection Guidelines. 14. Subsequent authorization/denial of services for benefit plan using Service Selection Guidelines. 15. Initial assessment and authorization of emergency services, psychiatric inpatient services, crisis residential services and crisis stabilization services using Service Selection Guidelines. 16. Subsequent assessment and authorization of emergency services, psychiatric inpatient services, crisis residential services and crisis stabilization services using Service Selection Guidelines. 17. Initial authorization of services to individuals receiving community-based services using Service Selection Guidelines. 18. Subsequent authorization of services to individuals receiving community-based services using Service Selection Guidelines. 19. Utilization Review oversight. Establishing a basic standard for conducting UR activities (i.e. concurrent stay reviews, clinical chart reviews, retrospective reviews). Ensuring CMHSPs have the appropriate tools to establish medical necessity (i.e. SSG s). When: On-going 20. Standardize utilization review processes across region. Review SSG s annually and disseminate to CMHSPs for use in determining medical necessity during the utilization review process. Provide guidance in applying SSG s to utilization review, recertification, and medical necessity criteria. When: Annual 21. Perform utilization review activities. (including prospective, concurrent, and retrospective) 22. Ensure utilization review decision makers are supervised by qualified professionals. Establish a standard and policy which identifies the appropriate / minimum credentials and licensure for an individual supervising the staff involved in UM/UR decisions. When: Annual 23. Ensure utilization decisions are made by professionals with appropriate clinical expertise. Identified by scope of practice and licensure. Establish a standard and policy which identifies the appropriate / minimum credentials of the clinical professionals making UM/UR decisions. When: Annual 24. Ensure consultation with treating providers prior to issuing a utilization review decision. 25. Communicate provider and recipient utilization review appeal options. 26. Supply providers and recipients with notification of processes for filing an appeal. 27. Documentation requirements, including form and format, reporting requirements and time frames. Identify reporting requirements from the state and communicate to CMHSPs the following: data to be submitted to the LRP, how the data should be submitted and in what format, and when the data should be submitted. When: Annual 28. Notification requirements, including form and format, reporting requirements and time frames. The LRP will establish a mechanism, standard, and timeline for notifying CMHSPs that data / reports are due to the LRP for submission to the state. When: Annual 29. Tracking and analysis of utilization reviews.(logs or other documentation)

4 30. Report utilization review decisions quarterly. 31. Implementation of utilization management requirements and decisions initiated in the Person-Centered planning process or other situations impacting care. Develop Recovery language into documentation processes. 32. Waiver certification process review. The UM Oversight Committee does an annual review of waiver enrollment requests and evaluates based on the medical necessity of each waiver program. When: Annual 33. Utilization Management reporting. Compile and provide to LRP executive team aggregate reports from CMHSPs. Maintain aggregate reports in a central repository for access as needed. The reports include under/over utilization and service cost for the region and CMHSP. When: Annual 34. Quarterly aggregate reports based on reviews. Using data from CMHSPs, the LRP will compile quarterly aggregate reports related to utilization in the region. When: Quarterly 35. MDCH Contractual requirements for Service and Utilization Management oversight Annual review of service and utilization management oversight processes, including jail diversion, coordination of care and school to community transitions. When: Annual 36. Beneficiary service records LRP will maintain client records that include information related to the timeliness, appropriateness, quality and quantity of services. Records may be paper or electronic. The UM Oversight Committee will review a policy which outlines this standard as stated in the MDCH contract. 37. Other service requirements LRP will ensure that services are provided in a manner that is consumer driven, inclusive with the broader community, and are not affected by where a consumer lives. 38. Coordination of Care LRP will ensure that care coordination occurs with other relevant systems and providers such as the primary care provider (PCP), Medicaid Health Plan, and community agencies / organizations. 39. Jail Diversion LRP will ensure that each CMHSP provides jail diversion services for individuals with either a mental illness or developmental disability who come into contact with the criminal justice system. 40. School-to-Community transition LRP will ensure that individuals who have been served in the special education system are assisted in the transition to adult life and services. 41. EPSDT screening process LRP will ensure that children identified will receive screening. 42. Self Determination LRP will ensure Self Determination is made available. 43. Supports Intensity Scale Oversight Ensure that each individual age 18 and older with an Intellectual/Developmental Disability is assessed using the Supports Intensity Scale (SIS) at minimum of once every 3 years. When: Annual 44. SIS Assessors Ensure an adequate cadre of trained and AAIDD recognized as qualified SIS assessors across its region to ensure that all individuals are assessed in the required timeframe.

5 45. SIS Training Provide for an adequate number of recognized and approved trainers to assure capacity to train new assessors. 46. Participate in statewide SIS implementation workgroup 47. Collaborate with BHDDA to plan for and participate in stakeholder SIS related informational forums 48. Collaborate with BHDDA in planning and provision of training to Supports Coordination/Care Management staff 49. Ensure SIS assessors meet state specified required criteria as identified in the PIHP contract 50. Ensure that SIS data is entered into or collected using SISOnline, the AAIDD web-based platform designed to support administering, scoring, and retrieving data and generating reports ( within state specified time frames. 51. Provide for necessary DUA s and related tasks required for use of SIS online. 1. Information Technology oversight. To provide leadership and guidance in the area of information technology (IT) and information management (IM). IT leadership will include: establishment and oversight of information systems processes and policies which will ensure compliance with state, federal and industry standards. Meet all of the State reporting requirements and comply with HIPAA and HITECH Act. The advisory team will include representation from each CMHSP and will provide input into the development of IT plan and processes being used across the region. When: On-going 2. Develop and maintain policies and procedures. Develop and disseminate broad level IT policies and procedures which address compliance with MDCH standards and provide regional consistencies for information technology processes. When: Annual 3. Develop and facilitate a regional Information Technology plan. Construct and implement a plan on an annual basis that identifies the key projects and technologies that are needed for the LRP. When: Annual 4. Develop procedures for maintaining and using regional data, including data assumptions, data gathering methods and data transmission requirements. Define and build data structures to support data in a warehouse environment using current industry standards so that the ware house can be supported sufficiently. The transmission methods between CMHSPs and LRP will use secure processes. When: Annual 5. Define data submission schedule, including data standards and timelines by file type. Supply data specifications and file formats for QI, Encounter, TEDS. Provide dates due to LRP. Any data that is required by MDCH or that is retrieved by the LRP on behalf of the CMHSPs will have a date/time scheduled associated. This schedule will be made available to all advisory team members and each data file will be clearly defined. When: Annual

6 RESPONSIBILITIES GRID 6. Establish process to identify data errors and process to correct them prior to submitting them to MDCH. In order to provide the oversight necessary to keep the region compliant and to provide a high-level of data accuracy, the LRP will build validation rules and document these for any data submitted to MDCH. When: On-going 7. Investigate non-compliance of 95% data submission standard by MDCH. Request plans of correction from CMHSPs when 95% standard is not met. Investigate non-compliance of 95% data submission standard by MDCH. Submit written plans of correction to the LRP when below standard. 8. Build process to uniquely identify individuals served in the region. The Lakeshore Unique Consumer ID (LCID) will be used by LRP, CMHSPs and CAs. An important aspect of regional data processing and submission is to provide a method for uniquely identifying each person served within the region so that the person can be commonly identified throughout the region. When: On-going 9. Participate in health information exchanges within the region. 10. Develop and maintain HIE policies and procedures.(including information exchange protocols) Ensure that standards and protocols are implemented in HIE processes. Develop broad HIE policies and procedures which address security while exchanging protected health information and using industry standards. When: Annual 11. Maintain population management dataset for the region to evaluate performance and to interact with other entities such as: MDCH, Medicaid Health Plans. Regional data disseminated by MDCH requires storage and management by the LRP, along with processes to distribute and/or make this big data available to the CMHSPs. Data use agreements and Business Associate Agreements will be reviewed and signed as needed so that the LRP can participate in these processes. When: On-going 12. Define functional tool data, outcome data, and other required data records for combining and using with regional data for population management. Develop a schedule and process for retrieval. As new requirements are defined, provide dates due to LRP. Any data that is required by the LRP for building population management analytics will have a date/time scheduled associated. When: Annual 13. Maintain population management dataset at community level and detail level for its day to day operational needs. 14. Establish process to properly bill for Children s Waiver, SED DHS and other waivers. Responsible for setting up IT staff access to these systems. Use Prevention system to record information and download data as appropriate. Compile all the data within respective counties. Provide access to MDCH database containing 820/834 transactions for these waivers for CMH. Download that data to use for CMH analysis. Encounter/claims data that is processed through the LRP will be stored and maintained in a centralized process. Data will be distributed to each CMHSP. When: Monthly 15. Establish parameters for data assumptions and data extractions to ensure validation of QI files. An agreed to set of data assumptions is clearly documented and used to validate QI files. When: Annual 16. Submit QI files 8-10 days prior to the end of the current month after claim is adjudicated. 17. Accept QI files, aggregate QI data and submit to MDCH. Provide a secure method of transmission for CMHSPs to post QI files. When: Monthly 18. Maintain QI file submission information in data warehouse. Each file will be stored and maintained in a central location to support the overall process. When: Monthly

7 RESPONSIBILITIES GRID 19. Use algorithm to uniquely identify consumers within the region.(including when a consumer is served by multiple CMHSPs) Refer to LCID process above. When: Monthly 20. Monitor and provided feedback about 95% compliance for the region Aggregate the QI indicators and evaluate with MDCH standard. When: Quarterly 21. Establish parameters for data assumptions and data extractions to ensure validation of encounter files. LRP established data assumptions are clearly documented and used to validate Encounter files. When: Annual 22. Submit encounter files 8-10 days prior to the end of the current month after claim is adjudicated. 23. Accept encounter files, aggregate encounter data and submit to MDCH. Provide a secure method of transmission for CMHSPs to post Encounter files. When: Monthly 24. Maintain encounter file submission information in data warehouse. Each file will be stored and maintained in a central location to support the overall process. When: Monthly 25. Use algorithm to uniquely identify consumers within the region. (including when a consumer is served by multiple CMHSPs) Refer to LCID process above. When: Monthly 26. Receive error reports and request CMH corrections. Establish acceptable standards and timeliness parameters. On occasion, encounter data will have errors the MDCH rejects the records from being accepted into its system. The LRP will process error files and distribute those to the respective CMHSP. When: Monthly 27. Establish parameters for data assumptions and data extractions to ensure validation of SUD demographic files. An agreed to set of data assumptions is clearly documented and used to validate SUD files. When: Annual 28. Submit SUD demographic files 8-10 days prior to the end of the current month after claim is adjudicated. 29. Accept SUD demographic files from CMHSPs, aggregate SUD demographic data and submit to MDCH if needed. Provide a secure method of transmission for CMHSPs to post SUD files. When: Monthly 30. Maintain SUD demographic file submission information in data warehouse. Each file will be stored and maintained in a central location to support the overall process. When: Monthly 31. Use algorithm to uniquely identify consumers within the region. (including when a consumer is served by multiple CMHSPs) Refer to LCID process above. When: Monthly 32. Validate the data for compliance rules, such as: two open admissions for similar programs for the same person served. Aggregate the SUD admission and evaluate with MDCH standard. When: Monthly 33. Define validation requirements for data such as: PI Indicators (1, 2, 3, 4 and 12) conducted at annual site visit. Aggregate indicator reports and evaluate with MDCH standard. When: Quarterly 34. Develop IT audit procedures and coordinate IT audits. This includes: MiHIN security audit, MDCH and HSAG audits (including ISCA) and gathering appropriate documentation required. Develop procedures that address external audit processes. Coordinate the audits, utilizing staff expertise as needed from within the region. Store documentation necessary for audit processes in a central location. When: Annual

8 35. Security breach management and security risk mitigation processes. Develop procedures and utilize security software, intrusion detection methods and data logging (login, access, alteration and destruction). Account lockout and account suspension mechanisms follow the recommended guidelines. When: Annual 36. Data analytics oversight. Data supplied by MDCH will be managed by the LRP, along with processes to distribute and/or make this data available to the CMHSPs. Region wide analytics initiatives will be coordinated and the data evaluated for accuracy and integrity in order to be used for population management activities. Standardized methods of aggregating and reporting using analytical processes. Help with CareConnect360 as needed and staff capacity allows. When: On-going 37. Determine data analytics impact and need/capability for region. Work with the input of the Quality advisory team and the Utilization Management advisory team to determine what the level of need is for doing data analytics. Includes: population management studies, aggregate data review processes and specific case studies. When: Annual 38. Evaluate and implement data analytics software for region. Standardize the process for evaluation and rating software options, along with selection process. Supply training, documentation and project plan for implementing and using analytics software. When: Annual 39. Provider clinical data analytics software assessment, planning and implementation. (CareConnect360) 1. Compliance oversight. The LRP is responsible for appointing a regional Compliance Officer, developing a written Compliance Plan, developing and implementing regional policy, instituting a regional Compliance Committee, providing training and education related to compliance, communicating with identified CMHSP compliance professionals, identifying high risk areas, and responding to compliance issues. 2. Develop and maintain policies and procedures. 3. Develop and implement regional compliance plan. 4. Appoint and identify Compliance officer and contact information. 5. Develop required process for Notification of litigation for Medicaid. 6. CMHSP compliance program (42 CFR and Medicaid contract). CMHSP/CAs are responsible for developing local compliance programs that meet the requirements of the LRP as well as federal requirements. 7. Appoint administrative liaisons. Liaisons are individuals responsible for compliance for member agencies, and will communicate as needed with the LRP Compliance Officer. These also may be individuals assigned to the regional Compliance Committee. 8. Receive and track litigation issues. 9. Report litigation issues to LRP. 10. Oversight and audit of CMHSPs. 11. Compliance aggregate reporting. 1. Claims processing and adjudication/payment oversight. LRP is required to collect claims data from members, and to report on behalf of the region. The LRP will provide oversight to assure that data submitted is accurate and timely according to LRP established standards.

9 RESPONSIBILITIES GRID 2. Claims processing and adjudication/payment operations. CMHSP/CAs manage the process of claims adjudication at the consumer level, and submit required data to the LRP as specified in the IT section of this Responsibility Grid. 3. Coordination of benefits oversight. LRP will assure that CMHSP/CAs have adequate policy, procedure, and systems in place for COB. 4. Coordination of benefits operations. 5. Regional financial management operations. (including financial state reporting) 6. Develop and manage budgeting process for the region. 7. Provider financial management operations. 8. Risk management. (including ISF) 9. Revenue and Expense analysis and reporting. 10. Service/Cost reporting requirements and time frames. 11. Provide service/cost report information to region. Report each month a year to date report on projected annual savings or deficits for Medicaid, general fund, and local match. Due the 15 th of each month and reports 2 months behind current month. 12. Compile, review and report to MDCH DEG reports to members within 7 days of the information being available. 14. Provide monthly trend analysis reports relative to Medicaid eligibility and rates. 15. CMHSP risk development and reporting to region. 16. SUD Revenue and Expenditure Report (RER) Initial by September 24 th for next fiscal year. 17. SUD 1 st Quarter Financial Status Report (RER) by January 23 rd 18. SUD 2 nd Quarter Financial Status Report (RER) by April 23 rd 19. Mid-year financial status report (annual and required to LRP by May 23 rd for current fiscal year) 20. SUD 3 rd Quarter Financial Status Report (RER) by July 23 rd 21. Medicaid projection report (annual and required to LRP by August 8 th for current fiscal year) 22. SUD Preliminary Closeout Report Due 1 week before September due date (Current Date has not been set by MDCH) 23. Medicaid year-end accrual SCHEDULE (annual and required to LRP by October 8 th for previous fiscal year) 24. All interim financial reports (annual and required to LRP by October 31 st for previous fiscal year) 25. Fraud and abuse complaints report (annual and required to LRP by December 31 st for previous fiscal year) 26. SUD Primary Prevention Expenditures by Strategy Report by January 23 rd 27. SUD Revenue and Expenditure Report (RER) Final by January 23 rd 28. SUD Legislative Report/Section 408 by January 23 rd 29. SUD Special projects, Earmark funded by January 23 rd 30. All final financial reports (annual and required to LRP by February 20 th for previous fiscal year) 31. Medicaid Community Inpatient Psychiatric Services Expenditure Report by February 21 st 32. Administrative cost report (annual and required to LRP by March 23 rd for previous fiscal year) 33. Audit reports and other documentation (annual and required to LRP by May 30 th for previous fiscal year)

10 34. Immediate notification of the LRP when cost overruns are expected to occur. 35. CMHSP Trial Balance and Encounters for Standardization Reports to determine Administration and Direct Service amounts (TBD) 36. CMHSP financial and compliance audit. 37. Administration vs. Direct Care Thresholds (TBD) 38. Regional financial and compliance audit. 39. Evaluate financial and compliance audits. 40. Engage in regional rate setting working with Finance ROAT. 41. Engage in state rate setting, working with Finance ROAT in the process. 42. Evaluate the impact of Healthy Michigan across the region. 43. Need Function for ISF Management and Risk Management Strategy? 1. SUD Oversight Policy Board representing all 7 counties in region. 2. Budget review. 3. Service planning review. 4. Coordinating agency functions. 1. Provider network oversight. LRP will manage all direct contracts between providers and the LRP, and will conduct a review of each CMHSP member agency's provider network system. When: Meeting schedule for Committee will be developed. Annually a review of each CMHSP member will occur. 2. Establish and maintain provider network policies and procedures. (Including procurement). With advisory input of the Provider Network Committee, develop and maintain policies. When: All Provider Network policies will be reviewed annually. 3. Clinical services procurement (including RFP issuance, proposal evaluation, contract negotiation and award, etc.). 4. Manage system contracting (LRP to CMHSP/CA) and related contract management functions (e.g., site reviews). When: Annually a review of each CMHSP member will occur. 5. Manage provider contracting (CMHSP/CA to Provider) based on a procurement method that meets state and federal standards and in accordance with region policy, and related contract management functions (e.g., site reviews). 6. For all providers contracting directly with LRP, manage provider contracting based on a procurement method that meets state and federal standards and in accordance with region policy, and related contract management functions (e.g., site reviews). When: Policy will be reviewed annually. 7. Credentialing and privileging services (including primary source verification, background and reference checks, etc.). 8. Age and disability specific according to the populations served. 9. Verification prior to employment and at license renewal and at provider contract renewal. 10. Retain copies of licenses, registrations, and/or certifications. 11. Credential all LRP staff, and all providers contracting directly with the LRP, maintaining copies for LRP. LRP will meet all specifications as outlined in the LRP policy on Credentialing and Privileging, and will review this policy with advisory input from the Provider Network Committee. LRP will maintain documentation for all providers directly contracting. When: Annual review of Credentialing and Privileging policy.

11 12. Perform provider competency assessment services 13. Monitor provider performance relative to contract. The monitoring process will minimally assess performance and compliance indicators established by the region. 14. Assess provider capacity. Evaluate and redistribute resources where necessary to ensure timely access and necessary service availability to meet customer needs. (includes: interpreters, translators, and bi-lingual/bi-cultural clinicians) 15. Develop and maintain a process for regional review of service availability and capacity. Develop a regional capacity report annually which specifically identifies areas of shortage and need in the region. The LRP with the advisory input of the Provider Network Committee (PNC) will develop a process for evaluating regional service capacity and identified gaps. This process will include participation of each CMHSP member. When: Analysis to be completed annually. 16. Service Availability and Capacity: Assist in data gathering at the CMHSP level to assure comprehensive analysis is completed. 17. Provider network development process to ensure coordinated services and appropriate referrals. 18. Regional provider manual - Develop and update a regional provider manual. When: Provider Manual will be developed according to timeline of Provider Network Committee, and will be reviewed no less than annually. 19. Development of Regional provider directory. Maintain a list of regional providers as part of the development of gap analysis and the development of a consumer manual for the region. When: Annually. 20. Coordination of individual consumer care with Medicaid health plans. 21. Develop service coordination agreements with each of the pertinent public and private community-based organizations and providers for shared customers. 22. Coordination with all Medicaid Health Plans in the region. LRP will develop agreements with all Medicaid Health Plans, and will develop processes for assuring ongoing planning and communication with health plans. When: An agreement and process will be developed. 23. Advance Directives: Maintain written policies and procedures for advanced directives, and provide written information to adult beneficiaries. 24. Ensure consistent communication with and feedback from the provider network providers within the region. LRP will manage all contracts with the LRP directly, will support the Provider Network Committee, and will conduct a review of each CMHSP member agency's provider network system. When: Method and frequency for receiving input from the provider network will be developed by the PNC. 25. Develop and maintain a system for communicating with the provider service network within each CMHSP s area. 26. Provider network reporting requirements. LRP will submit network data when it is required, such as data required for the Annual Program Plan and Budget Submission. When: As specified contractually in the LRP contract with MDCH. 27. NEED SOMETHING RE: AFP required Contract/common application process for providers. Emphasis on LRP established and monitored standards for same.

12 1. Quality Management oversight. Develop and maintain a Quality Assessment and Performance Improvement Plan. LRP provides leadership in developing QI structures in the region, analyzing performance and quality data, identifying quality and efficiency goals, providing minimally an annual compliance and quality review of each member, and when necessary, requesting additional information and plans of correction. This function includes a Quality Management Regional Operations Advisory Team, which reviews standards and processes for the system. When: Quality ROAT meets twice monthly, and reviews will be conducted by the LRP at least annually. 2. QAPIP annual plan development for the LRP. Assure the plan is developed and communicate expectations and standards to members. When: Annually for each fiscal year. 3. Develop local Quality Improvement plans annually and systems for assuring plan is implemented. Assign agency QI Director. 4. Define QAPIP performance improvement projects and coordinate the collection of data and analysis, assuring reporting to MDCH is complete. When: Project will be selected according to MDCH schedule, and subsequent reports will also meet all MDCH standards for content and timeliness. 5. Participate in the development of LRP PIPs, and Implement QAPIP performance improvement projects at the local level. 6. Maintain compliance with regional QAPIP program plan and structure. 7. QAPIP results reporting. Assess findings from QAPIP, and report findings. Annually assess and evaluate the QAPIP. When: Annual assessment as part of the QAPIP approval by LRP Board. 8. External Quality Review: Prepare and coordinate all reviews associated with the external quality review process. 9. Provide date and feedback to other region defined performance improvement related initiatives. 10. Work with CMHSP provider networks to implement performance improvement processes. 11. Support other operational areas in Quality Improvement and standard setting activities, including: assist in defining clinical standards, service selection guidelines, intensity of services criteria, and best practices guidelines and protocols. When: Conduct annual review of these systems. 12. Establish and maintain quality improvement policies and procedures. When: Annual review of policies. 13. Medicaid MMBPIS aggregate reporting. CMHSPs report to the LRP using a standardized template and process according to a regional schedule. When: Quarterly data collected consistent with regional schedule. 14. Jail Diversion data aggregation and reporting. CMHSPs report to the LRP using a standardized template and process according to a regional schedule. When: Annual consistent with regional schedule. 15. Regional Entity compliance operations. LRP will implement a corporate compliance plan and structure for the region. This plan will specify processes for reporting and follow up to compliance issues. LRP will present compliance data and recommend revisions to the LRP Board. When: Annual review of compliance plan and reporting on findings. 16. Provider/Corporate compliance operations. 17. Medicaid critical incidents and sentinel events aggregate reporting. CMHSPs report to the LRP using a standardized template and process according to a regional schedule. When: Monthly data collected consistent with regional schedule.

13 18. Facilitate performance improvement committee and its review processes. LRP will provide leadership and support to the Quality ROAT, assuring that all assigned functions are completed. When: Meetings scheduled twice monthly. 19. Manage regional performance improvement projects (PIP). LRP quality staff provide management of the PIPs, presenting the plan and the ongoing data to the Quality ROAT. LRP QI staff also assure that consumers are involved in the selection and analysis of projects. When: Project is reported to MDCH according to required timelines. 20. Facilitate a regional BTRC oversight process which includes analysis of data trends and compliance with contractual standards. LRP will identify a process for gathering BTRC data at the regional level, and using the data for analysis. The LRP will review members BTRC structures and systems. When: Format and schedule to be developed. 21. Implement and maintain a behavioral treatment committee at the local level. 22. Develop regional standards for behavioral treatment plan review committee. When: Annual review of policy will be required. 23. Quality improvement reporting requirements, including form and format, and time frames. LRP will develop formats for each required report, and will maintain a schedule for required reports from CMHSPs. When: Reports provided consistent with regional schedule. 24. MMBPIS quarterly reports due 75 days after the end of the quarter for defined reporting period. 25. CAFAS reporting (annual and required to MDCH by November 30 th for previous fiscal year) 26. Coordinate Habilitation Support Waiver certification process, including management of waiver slots. LRP monitors available HSW slots and works with CMHSP members to prioritize consumers requiring HSW level of care. The LRP submits completed waiver applications to the MDCH. LRP authorizes re-certifications, and provides oversight of the region's HSW process. When: Ongoing 27. Completion of HSW clinical assessments, certification packets and re-certification packets. Assuring all required clinical information is updated in the WSA site. 28. Autism Waiver oversight. LRP authorizes applications for the Autism Waiver, including providing all necessary information to MDCH in order to obtain authorizations. LRP will provide oversight, including review of overall quality standards for timeliness. Communicate program updates and changes to CMHSP members, and inform members of MDCH decisions. When: Ongoing 29. Completion of Autism clinical assessments, certification packets and re-certification packets. Assuring all required clinical information is updated in the WSA site. 30. Waiver reporting requirements and time frames. LRP coordinates required reporting to the state on both the HSW and Autism Waiver, and coordinates all MDCH reviews related to these waivers. When: Ongoing 31. MDCH Contract Performance Objectives reporting. LRP assures that all reporting requirements for Performance Objectives are met according to state MDCH guidelines. When: Data will be submitted according to MDCH required timeline. 32. Develop standard definitions for data elements required. LRP identifies a quality improvement process which identifies common definitions and collection of data elements. When: Ongoing 33. Provide report information for Performance Objectives by July Aggregate and submit the required report tables to MDCH. When: Reports submitted consistent with MDCH schedule.

14 35. Compile, Aggregate and submit MDCH AFP section (a - d) reports. When: Reports submitted consistent with MDCH schedule. 36. Implement and coordinate the utilization of a Recovery Tool for the region. Assure process meets MDCH requirements, and report according to MDCH timetable. 37. Carry out coordination of data collection for recovery tool at the local CMHSP level. 1. Management and Administrative oversight. 2. Management of regional operations. 3. Develop and maintain human resources policies and procedures for regional operations, including employment. 4. Execute service agreements/contracts/leases for staffing regional employees. 5. Manage regional employee human resources processes. (Payroll, benefits, training ) 6. Ensure that Cultural Competency is defined and implemented in HR processes. 7. Assign/Appoint staff to represent LRP on Federal, State and Regional committees and workgroups 8. Medical direction and oversight. 9. Regional Board development and support. 10. Establish and support Board committees. 11. Provide Board member orientation. 12. Recommend Executive Board self-evaluation process. 13. Management/supervision of staff providing delegated functions.