Arizona Department of Health Services Division of Behavioral Health Services PROVIDER MANUAL Comm
unity Partnership of Southern Arizona (CPSA Edition) Pa
Section 8.2 Independent Case Review
8.2.1 Introduction
8.2.2 References
8.2.3 Scope
8.2.4 Did you know…?
8.2.5 Objectives
8.2.6 Procedures
8.2.6-A: Independent Case Review
8.2.6-B: Additional RBHA medical record review activities
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 or 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:
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Implementation of the Independent Case Review Tool; and
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Implementation of any recommended actions to improve performance.
8.2.2 References
The following citations can serve as additional resources for this content area:
AHCCCS/ADHS Contract
ADHS/RBHA Contracts
ADHS/TRBHA IGAs
Independent Case Review Tool
8.2.3 Scope
To whom does this apply?
All enrolled persons, their behavioral health records and service providers may be part of the Independent Case Review.
8.2.4 Did you know…?
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An independent entity, also known as a Professional Review Organization, conducts the
ge 8.2 -1 8.2 Independent Case Review Last Revised: 01/01/2004 Effective Date: 06/01/2006
Arizona Department of Health Services Division of Behavioral Health Services PROVIDER MANUAL Comm
unity Partnership of Southern Arizona (CPSA Edition) Pa
Independent Case Review.
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Independent Case Review results are used to assess the quality of behavioral health services.
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Each standard in the Independent Case Review Tool has pre-determined level of performance established by ADHS/DBHS.
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 Professional Review Organization and the T/RBHA by allowing access to provider staff, behavioral health recipients and their behavioral health records.
CPSA uses the ICR results in order to implement system-wide improvements. Providers will be expected to assist in analyzing the data, identifying areas that need improvement, implementing such improvements, and submitting updates in terms of approximating or meeting the standards for each of the ICR indicators.
8.2.6-B: Additional RBHA medical record review activities
In addition to the ICR, CPSA has an extensive system of monitoring its network and subcontracted providers. CPSA's main methods of obtaining ongoing improvement data are through the Annual Network Provider Profile and the Joint Site Reviews. The Annual Network Provider Profile consists of a representative sample of records for each provider being reviewed against the ICR and other quality of care standards. The Biennial Joint Site Reviews consist of CPSA staff teaming with Network staff and reviewing the Network’s subcontracted providers. Network and Subcontracted providers are expected to assist CPSA with both of these processes.
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