California External Quality Review Organization
Cal EQRO - Performance Improvement Project Reports
As required by Title 42, Code of Federal Regulations, Part 438, Subpart E, the Department of Health Care Services contracts with an External Quality Review Organization (EQRO). The EQRO conducts reviews of Mental Health Plans (MHPs) to analyze and evaluate information related to quality, timeliness, and access to Specialty Mental Health Services (SMHS) provided by California's 56 MHPs and/or their subcontractors to Medi-Cal beneficiaries. California EQRO for the Medi-Cal SMHS Program is Behavioral Health Concepts (BHC), Inc.
EQRO reviews consist of site visits, consumer (beneficiary) and family member focus groups, MHP and provider staff focus groups, data analysis and reporting, information system reviews, and the evaluation of MHP Performance Improvement Projects (PIPs). A PIP is a focused effort to improve specific administrative or clinical performance in order to improve access to and quality of SMHS. MHPs maintain at least two active PIPs at a time with one focusing on a clinical area and the other on a non-clinical area.
Each EQRO review is summarized in an individualized MHP report. Information included in individualized MHP reports is also included in an annual statewide summary report. In addition to individualized MHP reports and the annual statewide summary report, BHC publishes quarterly PIP reports. EQRO reports are published on the BHC Internet Web site and can be viewed under the Reports and Summaries Tab.
Special Term and Condition # 3 requires that the state provide the EQRO’s quarterly PIP reports and annual summary report to the Centers for Medicare and Medicaid Services (CMS).
