Partners is responsible for assuring the quality of services delivered by the Provider Network. Likewise, Partners is accountable to the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS) and the Division of Medical Assistance (DMA) in the management of both State and Medicaid services.

In addition to state requirements, Medicaid Waiver quality requirements are extensive and include

  • Health and safety of enrollees
  • Rights protection
  • Provider qualifications
  • Enrollee satisfaction
  • Management of complaints
  • Incident investigation and monitoring
  • Assessment of outcomes to determine the efficacy of care
  • Management of care for special needs populations
  • Preventive health initiatives
  • Clinical best practice

Monitoring

Providers and Practitioners receive a monitoring review at least once every two years. The Quality Management Department maintains a schedule of monitoring reviews. A member of the Monitoring Team will contact the provider agency to schedule and coordinate a review.

Monitoring reviews use standardized state tools that are available in the Division of Mental Health/Developmental Disabilities/Substance Abuse Services’ Provider Monitoring webpage.

More details regarding Monitoring are available in the Provider Operations Manual.

Health & Safety Site Review

If a Health and Safety Site visit is required, a network monitoring specialist will schedule a site visit within 60 days the receipt of a complete, written application. If a provider requests to add a site to the contract, the site will be reviewed in all applicable areas. During the site visit, Partners’ monitoring team evaluates the provider’s readiness to provide services according to the requirements outlined in state regulations, the service definition(s), and the Partners’ contract.