Clinical Quality Review Team (CQRT)

1
Clinical Quality Review Team (CQRT)

• A Guide to the Authorization Process for Alameda
  County Behavioral Health Plan Members

2
CQRT Purpose

• Providers are expected to attend a CQRT sponsored
  by the County in the first year of operation.
  And, then develop an internal policy and
  procedure to guide the chart review process.
• The purpose of the CQRT is to review medical
  necessity, service necessity, review the quality
  of the chart, and authorization of services.
• The BHCS CQRT committees meet a minimum of one
  time per month representing the Adult Outpatient,
  Childrens Outpatient, Day Treatment and
  Outpatient EPSDT Expansion Programs in their
  first year of operation.
• Day Treatment Authorization is ongoing.

3
Learning Objectives

• Understand the purpose of the CQRT and its
  function in improving compliance with
  documentation standards.
• Understand the distinction between the Clinical
  Quality Review.
• Understand the expectations of how to prepare and
  participate in Alameda County BHCS CQRT meetings.

4
Learning Objectives

• Understand the forms and paperwork necessary to
  participate in Alameda County BHCS CQRT meetings.
• Understand the Clinical Review Cycles of charts
  and how they guide clinical practices.
• Be able to facilitate and/or improve ongoing
  internal Clinical Quality Review Teams.

5
BHCS CQRT Process

• Does not eliminate audit risk but assists the
  provider in reducing risk of audit disallowances.
• Is not a substitute for a providers internal
  Quality Assurance (QA) process.
• The DHCS has the ultimate authority regarding
  Medi-Cal audits.

6
The Clinical Quality Review Teams will

• Review the chart to ensure that adequate
  treatment and discharge planning are documented
• Approve the continuation of services

7
CQRT Members are

• BHCS CQRT Chairpersons are licensed clinicians
• CQRT trained agency supervisors or their
  designees who provide their staff with direction
  regarding Quality Assurance requirements and
  issues/concerns identified by the CQRT
• Licensed clinicians, waivered psychologist
  candidates, or registered interns, Licensed
  Practitioners of the Healing Arts (LPHA)

8
The BHCS CQRT Meeting

• Representatives are apart of a team and review
  others charts.
• Participants will be reviewing charts from other
  agencies.
• Agency representatives are to receive training
  and orientation to the CQRT procedures by their
  agency staff Prior to their actual participation
  in the CQRT meeting

9
Schedule for Treatment Chart Review

• Charts are reviewed based on the date of the case
  episode opening. The review cycle begins on the
  first of the month in which the episode was
  opened.
• Outpatient and Rehabilitative Day Treatment
  charts are reviewed every six months.
• Day Treatment Intensive charts are reviewed every
  three months.
• The review cycles will always remain the same!
• MHS Report 485 notifies providers that the UC
  Authorization is expiring and due for a
  reauthorization

10
Timeline Examples for Outpatient and
Rehabilitative Day Treatment
Month Episode is Opened Period for Review Bring to the Chart to the CQRT during the month With a revised or new TX plan to start beginning And not signed before this date
January Jan 1-June 30 July 1-Dec 31 June December 7/1 1/1 6/1 12/1
February Feb 1-July 31 Aug 1-January 31 July January 8/1 2/1 7/1 1/1
March Mar 1- Aug 31 Sept 1-Feb 28 August February 9/1 3/1 8/1 2/1
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Chart Review Cycle Exercise

• What is the Episode Opening Date?
• What is the Review Cycle Dates?
• When is the Assessment due?
• When is the Client Plan due?
• When is the Chart due in the CQRT?

12
Guide to Chart Content for CQRT

• Charts must contain all of the elements required
  by Medi-Cal Documentation Guidelines.

13
Clinical Review

• The Clinical Review ensures that ongoing Medical
  Service Necessity has been documented.
• Is there a Treatment Plan, included diagnosis,
  and corresponding Progress Notes?
• Is there evidence that progress is being made
  toward the goals/objectives and is the client is
  benefitting from treatment?
• Is there an appropriate discharge plan or
  tentative discharge plan?
• Are the required dated signatures, Community
  Function Evaluations, and Informing Materials
  present?

14
Quality Review

• The Quality Review is more comprehensive
• The chart is reviewed using the Regulatory
  Compliance checklist on the back of the CQRT
  Review Request Form
• It includes a Clinical Review
• There must be a continuity between the Assessment
  Included Diagnosis, the Treatment plan, and the
  treatment documented in the Progress notes

15
CQRT

• Fifteen percent (15) of all charts presented at
  CQRT meetings will be randomly chosen for Quality
  Review.

16
Deficient charts

• In the BHCS CQRT, charts with deficiencies are
  given a months authorization and must be
  corrected prior to return.
• Medical Necessity has not been established
• Service Necessity has not been established
• Intervention Criteria
• Impairment Criteria
• Client Plan Missing
• Signatures Missing on TP, Client Plan, Progress
  Notes
• Progress Notes are found to be out of compliance
• Other recurring patterns of non-compliance
•  

17
Meeting Schedules

• BHCS CQRT meetings are organized by the type of
  provider or primary treatment mode.
• Meeting assignment is determined by the BHCS.
• Schedules are posted on the BHCS website at
  www.acbhcs.org

18
Final CQRT Advice

• Train and familiarize your staff with the CQRT
  process.
• Develop a written agency QA Policy Procedure
  Manual.
• Supervisors reviewing charts and returning to
  staff for correction prior to reviews will reduce
  deficiencies and the need for time consuming 30
  day returns.
• Reach out to other providers and develop a
  inter-agency CQRT process.

19
Questions and Answers

• Questions

20
Post Training Questions?

• QA Contact Information
• For questions, limit 1 contact person per
  provider to maintain consistency of information
  at your agency.
• Michael De Vito, MFT, MPH
• mdevito_at_acbhcs.org
• Tiffany Lynch, QA Secretary
• tlynch_at_acbhcs.org