Bureau of Quality & Integration

Evaluation: Operational and Financial Review

This Division-wide process evaluates the RBHAs' performance against contract and policy/procedure requirements in the areas of general management, network management, network development, cultural competency, member services, personnel, planning, medical staff, grievance and appeals, utilization management, quality management, clinical management prevention, claims and encounters, financial management (access to services, emergency services, case management, service planning and monitoring, clinical supervision and training, confidentiality, and special populations such as IV drug users, pregnant/parenting substance abusing women, and HIV infected clients), and information management.

The RBHA Annual Operational/Financial Review Guide was updated for FY 1999 to reflect ongoing RBHA monitoring activities. The 1999 Review focused on verification that RBHA corrective actions had been effectively implemented and were producing expected and desired results. ADHS/DBHS implemented corrective action tracking matrices for each RBHA in order to oversee the corrective actions to their satisfactory implementation or completion. A statewide tracking matrix was developed which displays compliance with ADHS/DBHS standards across all RBHAs. In addition, at the beginning of the 1999 Operational/Financial Review cycle and in preparation for the reviews, ADHS/DBHS completed an analysis of the standards with which the RBHAs had fully complied, and those for which partial compliance was still evident statewide, e.g statewide compliance by 25%, 50%, and 75% of the RBHAs. ADHS/DBHS is using this information to focus technical assistance efforts to the RBHAs and to inform policy revision at the state level.