The Bureau of Quality Management and Data Review utilizes proven methodologies and evidence-based practices to ensure that individuals with mental illness and/or substance use disorders, along with their families, receive high-quality services from the Department of Human Services.
Furthermore, this bureau is committed to giving those under our care a voice in the oversight and improvement of the services they receive.
Divisions
The Systems Management Division identifies, collects, and analyzes data from counties, managed care organizations, and providers to monitor data sources and quality. The Division also generates performance outcome reports for federal agencies, the Commonwealth, and OMHSAS, detailing service utilization, costs, and the characteristics of individuals receiving services. Additionally, staff support the development and enhancement of system capabilities to ensure accurate data collection, enabling OMHSAS to report on services provided and assess their outcomes effectively.
The Quality Management Division oversees the quality and effectiveness of the behavioral health program. Staff assists with the development and implementation of a Quality Management work plan and the Department’s Quality Strategy which outlines specific activities, measures, and indicators central to the OMHSAS’ focus on quality management. Staff are also responsible for overseeing managed care organization and county compliance as well as member satisfaction, complaint, grievance, and appeals processes.
The Division of Clinical Review is responsible for reviewing Medicaid Fee for Services requests for authorization of Inpatient Psychiatric Services, Residential Treatment Facilities for children, and Intensive Behavioral Health Services (IBHS). Staff also review Omnibus Budget Reconciliation Act (OBRA) requests for nursing facility placements to ensure that those with an identified mental health disorder can be effectively served within a nursing facility. Further, Division staff process requests for appeals of adverse Fee for Service authorization determinations and OBRA determinations.
Contact
the Bureau
Director
Amanda Roth
P. O. Box 2675
Harrisburg, PA 17105-2675