Washington Medicaid projects and activities

External quality review activities

Web pages for Washington MCOs and RSNs (Medicaid Quality Management meetings, RSN PIPs, contact information)

As Washington’s Medicaid External Quality Review Organization (EQRO) since 1994, Acumentra Health performs federally mandated and optional EQR-related activities to support quality improvement in the Medicaid program. These activities involve review of managed medical services delivered by managed care organizations (MCOs) and of managed mental health services delivered by Regional Service Networks (RSNs).

Mandatory activities include

  • reviewing RSN compliance with regulatory and contractual provisions governing managed care (mental health only)
  • validating RSNs’ performance improvement projects (PIPs—mental health only)
  • validating performance measures. For physical health, Acumentra Health annually collects, audits, and reports on the MCOs’ HEDIS® measures. For mental health, Acumentra Health validates statewide measures used to compare RSN performance; this activity includes audits of RSN information systems.

Optional activities include

  • conducting annual CAHPS® surveys of consumer satisfaction with the medical services provided by MCOs
  • performing encounter data validation (mental health only)
  • performing a study of the quality of mental health services delivered by RSNs

More information

Contact

Last updated April 27, 2011