Provider Alerts

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Date:	June 28, 2019
To:	Health Plan of San Joaquin (HPSJ) PCP sites and Facilities
From:	HPSJ Quality Management Department
Subject:	Revised DHCS FSR/MRR tool
Business:	Medi-Cal Managed Care

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Health Plan of San Joaquin (HPSJ) is charged with maintaining the quality of care for our members. Therefore, each of HPSJ’s contracted PCP sites is subject to an initial site review and periodic site reviews thereafter.

These consist of:

• A facility site review (FSR)
• Medical records review (MRR)
• The Physical Accessibility Review Survey (PARS) tool to evaluate the site’s capacity to deliver quality services

This alert is to inform all HPSJ PCP sites and facilities of the updates to the Department of Health Care Services (DHCS) site review policy. This policy reflects changes made to the criteria and scoring of the DHCS audit tools.

DHCS updated these criteria to:

1. Reflect current guidelines of professional organizations
2. Unbundle these criteria groups for better identification of deficiencies
3. Adjust scoring methods for improved generalization of scores

Reviews Timeline

• July 2019-September 2019
  • HPSJ will test the new DHCS tools during the scheduled FSR/MRR.
    
• July 2019-June2020
  • HPSJ will use the new tools during scheduled FSR/MRR and begin provider training.
  • HPSJ will track provider scores for both the old and the new tools.
  • Provider CAPs may be established based on results of the old tools during this timeframe.

HPSJ has an obligation to our members to ensure that the highest level of quality care is rendered by participating providers. HPSJ monitors this activity, and advises and works collaboratively with providers regarding areas of opportunity related to these mandated reviews.

Thank you very much for being our partner in our commitment to provide quality care to HPSJ members.

If you have any questions, please contact our Quality Management Department at
209.461.2383; from Monday – Friday, 8:00AM to 5:00PM.