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8.2.1
Introduction
ADHS/DBHS is required to oversee the performance of an Independent
Case Review (ICR) to ascertain the extent to which established guidelines
regarding access to services, timeliness of services and quality
outcomes are being adhered to in the public behavioral health delivery
system. The Independent Case Review is an annual evaluation of the
statewide behavioral health system, conducted by a Professional
Review Organization, to assess contractor performance and to identify
areas of needed improvement in the provision of behavioral health
services. Currently, the evaluation process is primarily conducted
through case reviews but may also involve interviews of behavioral
health recipients and others involved (e.g., service providers)
when deemed necessary. Independent case review findings are utilized
to improve care for persons receiving behavioral health services.
This section provides an overview of the Independent Case Review
and describes expectations for behavioral health providers to assist
with:
- Implementation
of the Independent Case Review Tool; and
- Implementation
of any recommended actions to improve performance.
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8.2.2
References
The following citations can serve as additional resources for this
content area:
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8.2.3
Scope
To whom does this apply?
All behavioral
health recipients and their behavioral health records and service
providers may be part of the Independent Case Review.
8.2.4
Did you know…?
- An independent
entity, also known as a professional review organization (PRO)
or an EQRO, conducts the Independent Case Review.
- Independent
Case Review results are used to assess the quality of behavioral
health services.
- Each standard
in the Independent Case Review Tool has pre-determined level of
performance established by ADHS/DBHS.
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8.2.5
Objectives
To describe behavioral health provider’s obligations
regarding the Independent Case Review.
8.2.6
Procedures
8.2.6-A.
Independent Case Review
Behavioral health providers must cooperate with ADHS, the
independent Professional Review Organization and the T/RBHA by allowing
access to provider staff, behavioral health recipients and their
behavioral health records.
The Gila River
RBHA coordinates with ADHS to ensure that the independent entity
conducting the review has easy access to clinical records included
in the Independent Case Review (ICR) sample. Behavioral health providers
must make clinical records available to the Gila River RBHA upon
request and implement any recommended actions to improve performance.
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8.2.6-B.
Additional RBHA medical record review activities
In addition to the ICR, the Gila River RBHA conducts periodic
case file reviews by a master’s level clinician to assess
the overall quality of care provided to Gila River RBHA behavioral
health recipients. The scope of the review includes an assessment
of the quality of covered behavioral health services provided directly
by the RBHA as well as care and treatment provided by behavioral
health providers within the network. Findings from case file reviews
are analyzed and trended and are reported to the Gila River RBHA’s
Quality Management Committee. Corrective action may be required
of behavioral health providers based on case file review findings.
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8.2 Independent Case Review
Last Revised: 12/08/2005
Effective Date: 06/01/2006 |
