MINIMUM REPORTING REQUIREMENTS

CAMHD requires submittal of the following reports as determined by the respective department outlined below.

1. Monthly Treatment and Progress Summary (MTPS)

Contractors must electronically submit youth-specific monthly treatment and progress summary reports to the appropriate CC by the 5th day of each month describing the provided service and progress of the youth and family during the preceding month. The report must specify youth served, service format, service setting, service dates, treatment targets, progress ratings, intervention strategies, medications and dosage. Additional outcome measures may also be reported.

The report should be completed by the clinician(s) most familiar with the youth and family’s treatment and progress and must be verified for accuracy, signed and dated by a qualified provider. If multiple clinicians within an agency have worked with the youth and family during the month, the clinician completing the MTPS should gather relevant information from others to comprehensively complete the form. The form that must be used for this purpose is the

http://hawaii.gov/health/mental-health/camhd/library/pdf/paf/paf-002.pdf), and the “Instructions and Codebook for Provider Monthly Summaries” (See website http://hawaii.gov/health/mental- health/camhd/library/pdf/paf/paf-001.pdf). Contractors are responsible for ongoing training of their clinicians and supervisors in accurate completion of the MTPS. A videotape of the statewide training on the MTPS is available from the CAMHD Clinical Services Office.

2. QUALITY ASSURANCE (QA) REPORTS

All Contractors must maintain Quality Assurance Programs, document their Quality Assurance Plan, and submit Quality Assurance Reports.

Quarterly QA Reports

Contractors must submit quarterly Quality Assurance Summary reports that are based upon the agency’s quality assurance and improvement program that define measurable indicators for identified clinical and non-clinical process and outcome objectives. These reports state the findings and analyses conducted as well as actions that have been or will be taken by the agency following its quarterly review.

Contractors must report the following components, to the CAMHD Performance Management Section every quarter, no later than forty-five (45) calendar days following the end of each quarter. Forty-five days are allowed to give Contractors the time to complete the quarter’s data collection and to analyze the data in their quality assurance committee(s). The quarterly Quality Assurance Summary report is to include the following information:

a. Sentinel Events:

• An analysis, including numbers, types and identified trends and patterns including issues/problems that accounted for the sentinel events

• A discussion of significant findings with opportunities for improvement identified

• Specific actions taken to impact youth care

b. Clinical Supervision:

• Adherence to supervision requirements, as indicated by the CAMHD supervision standards

• Analysis of performance of supervision program practices

• Description of any barriers to implementing supervision according to CAMHD supervision standards

• Opportunities for improvement identified with actions taken to impact effectiveness of supervision

c. Clinical Documentation:

• Completeness, quality and timeliness of clinical records and progress notes based on chart review conducted through a tool that reflects CAMHD requirements.

• Findings of internal chart reviews

• Opportunities for improvement identified

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General Performance Standards

d. Facility (if applicable):

• Brief analysis of facility condition: Status of facility maintenance including cleanliness, needed repairs and safety based upon routine, procedural inspections

• Opportunities for improvement identified and actions taken

• Steps taken to create and sustain a home-like engaging, family-friendly atmosphere

• Facility or administration office relocation plans.

e. Highlights of Other Significant Quality Assurance Finding and Accomplishments:

• List Quality Assurance Findings and other key accomplishment during the quarter

f. Status of Corrective Action/Improvement Plans:

• A copy of the current Corrective Action/Improvement Plan must be attached to the report with updates to completion date and outcome of developed activities/strategies

g. Contractor Quality Assurance Meeting Agenda and Minutes

• Submit agendas and minutes for meetings held regarding quality issues conducted during the quarter including summary of any focused reviews and/or special studies planned or conducted. Minutes should include only those activities related to CAMHD contracts/programs.

3. FACILITIES INFORMATION REQUIREMENTS:

Applicable Contractors are required to meet all facilities certification requirements as requested by the CAMHD’s Facility Certification Specialist including:

• Staff schedules

• List of key facility personnel/consultants with location/phone numbers

• Copy of written information regarding residents/client rights

• Abuse Prohibition Review

• Medication pass time

• List of CAMHD clients’ admissions during the past three (3) months

• Copy of facility’s physical layout

• Tracking system for incidents/accidents/sentinel events

• List of new employees for the past six (6) months

• List of paraprofessionals; date of hire, list of paraprofessionals hired in the last six (6) months

• Credential of licensed/registered/certified personnel

• Contract for arrangement of services not provided by facility

• Policy and Procedure Manuals

• Program/Plans and Committee minutes for the past year

• Prevention Maintenance Records

• Pre-employment and annual health evaluation/TB clearance of employees

• In-service education records

• Other documents as requested

4. CAMHD SUMMARY OF LICENSING CORRECTIVE ACTIONS AND ANY REQUIRED DELIVERABLES:

Applicablecontractorsmust provide a summary of corrective actions and required deliverables that result from desk or site reviews conducted by CAMHD’s Facilities Certification Specialist to Department of Health CAMHD and Office of Health Care Assurance (OHCA).

5. CAMHD SENTINEL EVENTS:

All sentinel events, as defined in the CAMHD Sentinel Event Policy and Procedure 80.805 (See Appendix 9), shall notify the youth’s parent/legal guardian and CC within twenty-four (24) hours of occurrence by fax or phone and submit a written hard copy report on the CAMHD 72-Hour Sentinel Event Report Form (See Appendix10) submitted to CAMHD Sentinel Events Specialist and the CAMHD Branch within three (3) business days of the event.

6. CAMHD ACCREDITATION:

Current Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Council on Accreditation of Rehabilitation Facilities (CARF), or Council on Accreditation (COA) is required. All Contractors shall submit evidence of current accreditation to CAMHD Performance

Management Section.

7. CAMHD WEEKLY CENSUS REPORT ON CLIENT STATUS AND WAITLISTED YOUTH

All out-of home levels of care including Transitional Family Homes, Multidimensional Treatment Foster Care, Therapeutic Respite Home, Community-Based Residential Programs, and

Hospital-Based Residential treatment service are required to submit a CAMHD Weekly Census Report on Client Status Form. (See Appendices B-12 & 13) in standard format to CAMHD’s Clinical Services Office, Utilization Management section no later than Tuesday noon of each week either by fax or electronically.

8. CAMHD ATTENDANCE AND ENCOUNTER RECORDS:

Attendance records and encounter records must be maintained at each facility for prescribed program activities. Residential facilities must maintain a log of whole day and/or night absences from both program and residence whether authorized or not. Such records are filed in the youth’s file and made available to CAMHD upon request.

9. CAMHD TITLE IV-E ADMINISTRATIVE REPORTS:

In accordance with CAMHD’s efforts to maximize federal reimbursement, quarterly submission of Title IV-E training activity and cost will be submitted via the Contracted Agency Quarterly Training Report (See Appendix 14) by applicable Contractors to the CAMHD Fiscal Section is required, using standard training reporting forms.

10. Other specified reports/documents periodically requested by the CAMHD.

CAMHD may periodically request specific information or documents to address specific issues or system needs. In making these requests CAMHD will be sensitive to the anticipated

resources required of Contractors to respond to such requests. Nevertheless, Contractors are expected to provide such information upon request by CAMHD.