Section 388-865-0264 - Behavioral health organizations Quality strategy A behavioral health organization (BHO) must implement a quality strategy for continuous quality improvement in the delivery of culturally competent mental health services. The BHO must submit a quality assurance and improvement plan to the division of behavioral health and recovery (DBHR). All changes to the quality assurance and improvement plan must be submitted to DBHR for approval prior to implementation. The plan must include all of the following:
(1) Roles, structures, functions and interrelationships of all the elements of the quality strategy, including but not limited to the BHO governing board, clinical and management staff, advisory board, behavioral health ombuds service, and quality review teams.(2) Procedures to ensure that quality assurance and improvement activities are effectively and efficiently carried out with clear management and clinical accountability, including methods to: (a) Collect, analyze and display information regarding:(i) The capacity to manage resources and services, including financial and cost information and compliance with statutes, regulations and contracts; (ii) System performance indicators;(iii) Quality and intensity of services;(iv) Incorporation of feedback from individuals, allied service systems, community providers, the behavioral health ombuds office and quality review team;(v) Clinical care and service utilization including consumer outcome measures; and(vi) Recommendations and strategies for system and clinical care improvements, including information from exit interviews of individuals and practitioners;(b) Monitor management information system data integrity;(c) Monitor complaints, grievances and adverse incidents for adults and children;(d) Monitor contractors and to notify DBHR of observations and information indicating that providers may not be in compliance with licensing or certification requirements;(e) Immediately investigate and report allegations of fraud and abuse of the contractor or subcontractor to DBHR;(f) Monitor delegated administrative activities;(g) Identify necessary improvements;(h) Interpret and communicate practice guidelines to practitioners;(j) Evaluate and report results;(k) Demonstrate incorporation of all corrective actions to improve the system;(l) Consider system improvements based on recommendations from all on-site monitoring, evaluation, accreditation, and certification reviews; and(m) Review, update, and make the plan available to community stakeholders.(3) Targeted improvement activities, including: (a) Performance measures that are objective, measurable, and based on either current knowledge or best practice, or both, including at least those defined by DBHR in the contract with the BHO;(b) An analysis of consumer care covering a representative sample of at least ten percent of consumers or five hundred consumers, whichever is smaller;(c) Efficient use of human resources; and(d) Efficient business practices.Wash. Admin. Code § 388-865-0264
Adopted by WSR 16-13-087, Filed 6/15/2016, effective 7/16/2016