Oregon Medicaid activities

OHP managed care integration project

Acumentra Health provides technical assistance to OHP managed care plans working on Performance Improvement Projects (PIPs) to improve integration of physical and mental health care. The initiative engages managed care organizations and mental health organizations in developing PIPs that use integrated care models to improve health outcomes. Acumentra Health guides the organizations in project planning and the quality improvement process.

Oregon DHS website for Health Services Integration

External quality review activities

As Oregon's external quality review organization (EQRO), Acumentra Health conducts reviews of OHP managed care organizations for the Addictions and Mental Health Division (AMH).

AMH website

For questions, concerns, or complaints about access to or outcomes of AMH review services, please call 1-866-432-8403.
 
Acumentra Health conducts the three federally mandated activities described below.

Compliance review

Acumentra Health reviews health plan compliance with federal and state regulations and contract provisions regarding enrollee rights, access to care, structure and operation, and quality measurement and improvement.

PIP validation

Acumentra Health annually validates the health plans’ PIPs, which are a required element of their quality improvement programs.

Performance measure validation

AMH uses statewide performance measures to assess the quality of healthcare services provided to OHP enrollees. As part of the validation of these measures, Acumentra Health assesses the health plans’ information systems used to calculate and report on the measures.

Mental health consumer satisfaction surveys

Since 2005, Acumentra Health has administered annual surveys of consumer satisfaction among adults (the Mental Health Statistics Improvement Project Survey for Adults) and children (the Youth Services Survey for Families) who receive managed mental health services through the Oregon Health Plan.

2010 Oregon Mental Health Statistics Improvement Project Survey for Adults (PDF)

2010 Oregon Youth Services Survey for Families

Utilization review

DMAP fee-for-service

Acumentra Health provided prior authorization and post-payment review services for Oregon’s Medicaid Title XIX fee-for-service program through the Division of Medical Assistance Programs (DMAP) from 1985 through 2010.

Mental health review

Acumentra Health conducts federally required quality and utilization review activities for all Oregon Medicaid Title XIX programs providing inpatient and residential treatment to Medicaid recipients under 21 years of age or 65 and older. Review settings include

• psychiatric inpatient hospitals
• psychiatric residential treatment centers
• assessment and evaluation programs

Using criteria derived from federal and state requirements, Acumentra Health conducts preauthorization of care for children served in psychiatric residential treatment facilities, approves stays for patients 65 years and older in psychiatric state hospitals and identifies quality-of-care concerns. Acumentra Health provides oversight of these facilities and programs and also identifies opportunities to improve care.