Office site visits are scheduled annually for the purpose of conducting treatment record documentation audits of high-volume Providers in order to monitor adherence to treatment record standards and to audit billing accuracy. The intent is for treatment records to be maintained in a manner that is current, detailed and organized, and which permits effective and confidential care. The quality review of treatment records is based on the applicable HealthChoices regulations governing each level of care. These indicators include the adequacy of documentation in treatment plans, progress notes, intake assessment, continuity and coordination of care, and discharge planning. High-volume Providers were identified by meeting all three of the following conditions:

• Provide at least one of the following high-volume services (Mental Health Outpatient Services, Behavioral Health Rehabilitation Services, Family-Based Mental Health Services)
• Serve at least a total of 100 unique Members in the Contract Year
• Have at least $100,000 in paid claims in the Contract Year

For the 2006 treatment record annual review, the CBHNP QI Committee set a performance goal of 70% compliance with the identified indicators. Across the network, BHRS and RTF services demonstrated compliance percentages above the 70% target. The focused Outpatient providers and the Targeted Case Management Services did not. CBHNP will work with Provider organizations who did not meet an average 70% compliance rating in instituting appropriate corrective actions. This included three Mental Health Outpatient providers, two BHRS providers, and four Targeted Case Management providers.

Across the network, CBHNP identified the following areas for continued improvement and encourages all providers to target these areas for improvement:

Criterion – Coordination with PCP	Compliance % 2006
	BHRS Network Average	TCM Network Average	OP Mental Health Network Average
Name/contact information for Primary Care Physician--PCP	56%	89%	88%
Coordination at the time of admission	39%	15%	38%
Coordination at time of medication change	11%	NA	17%
Coordination at the time of discharge	9%	0%	31%

Coordination and Continuity of Care	BHRS 2006 Network Average	TCM 2006 Network Average
The treatment record reflects continuity and coordination of care when applicable
-- with other mental health providers	91%	94%
-- with SA providers	0%	65%
-- with educational/ vocational systems	74%	90%
-- with child protective services	60%	89%
-- with juvenile probation	33%	93%

Discharge Summary	BHRS Network Average 2006
Reason for termination of treatment	60%
Aftercare and follow-up plan	60%
DSM-IV diagnoses for axes I-V upon discharge	56%

Clearly, Providers at multiple levels of care across the service system are routinely identifying and obtaining the necessary Authorization for Disclosure (Release of Information) to communicate with Primary Care Physicians. However, communication and coordination of the Member’s care, either in writing or documented verbal contacts, are not occurring in most cases, especially upon discharge. Members of course can choose not to share information with Primary Care Physicians or limit the information shared. If clearly documented in the treatment record, such refusals are considered a valid attempt at coordination.

CBHNP commends providers as they continue to provide quality treatment as indicated in quality indicators that show improvement and maintenance of sustained high ratings.