8/17/2012

Kesha Anderson

1113 Broadway Ste 101

Alexandria, MN 56308

DearKesha:

Ann Challes, RN, Complex Care Coordinator, and Icompleted amental health targeted case management (MH-TCM) care plan Individual Family Community Support Plan[IFCSP]) audit on August 15, 2012.

The purpose of the comprehensive care plan (ICSP and IFCSP)audit is to do the following:

·  Act as an ongoing benchmark from which to measure the current care plan process and establish standards for continuous quality improvement

·  Ensure compliance with the care plan protocol per sections 6.1.22, 7.1 – 7.3, 9.1, 9.3.4, 9.3.5, and 9.3.7 of the 2012 Families and Children contract; sections 6.1.25,7.1, and 9.3 of the 2012Special Needs BasicCare (SNBC) contract; and sections 6.1.24, 7.1 – 7.3, 9.1, and 9.3 of the 2012 Minnesota Senior Health Options/Minnesota Senior Care Plus(MSHO/MSC+) contract between PrimeWest Health and the Minnesota Department of Human Services (DHS)

·  Ensure an interdisciplinary, holistic, and preventive approach to determining and meeting the health care and supportive service needs of PrimeWest Health members

·  Strengthen relationships, trust, and respect and enhance communication between PrimeWest Health and its county partners

·  Identify opportunities for improvement

·  Provide oversight of delegated case management functions and ensure that MH-TCM is being provided to members with mental health conditions that meet Minnesota Statutory requirements for eligibility

·  Ensure the required components of care planning for PrimeWest Health members are being carried out in a timely manner consistent with the termsof the 2010contracts with DHS and in accordance with applicable State and federal laws and regulations

·  Reduce inappropriate resource utilization

·  Ensure coordination of care and services among multiple county case managers

·  Assess the adequacy of the current ICSP or the IFCSP

Outcome of the comprehensive care plan (ICSP and IFCSP) audit

All elements of the audit were weighted as a 1 or 2. Elements not met and weighted as a 1 resulted in a deficiency, or if an item weighted a 2 last year was not met again this year it resulted in a deficiency. Elements not met and weighted as a 2 resulted in a mandatory improvement. A total of 5 charts were reviewed for this audit.

·  The following elements weighted as a1were not met. Therefore, they are considered a deficiency and a Corrective Action Plan (CAP) will be required.

o  Functional Assessment needs are incorporated into the care plan Individual Community Support Plan (ICSP)) (13 charts of 30– Mandatory Improvement from 2011 audit)

Please provide a written Corrective Action Plan (CAP) that your county will be implementing to address the above area of concern by 9/10/2012. Enclosed is PrimeWest Health’s CAP worksheet to complete and return so PrimeWest Health. PrimeWest Health will need an updated CAP worksheet in 3/2013.

Please feel free to contact either Ann or me with any questions you may have regarding this letter or the audit process. I can be reached at 1-320-335-5283, 1-888-588-4420 ext. 5283 (toll free), or . Ann can be reached 1-320-335-5394, 1-888-588-4420 ext. 5394(toll free), or .

Thank you for actively participating with the audit. We appreciate your time and input!

Sincerely,

Catherine (Catie) Lee, MBA, QDDP

Integrated Care/Behavioral Health/SNBC Manager

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