Behavioral Health External Quality Review
BH EQR Annual Technical Reports - DMC-ODS & MH Services
Behavioral Health (BH) External Quality Review (EQR) is mandated by Title 42, Code of Federal Regulations, Part 438, Subpart E, requiring the Department of Health Care Services (DHCS) to contract with an External Quality Review Organization (EQRO) to fulfill these federal EQR requirements. California’s BH Prepaid Inpatient Health Plans (PIHPs) offer Specialty Mental Health Services (SMHS) and/or Drug Medi-Cal Organized Delivery System (DMC-ODS) services to Medi-Cal members throughout the state. The EQRO conducts the EQR of these PIHP Behavioral Health Plans (BHPs) to analyze and validate existing state and plan processes in alignment with the Centers for Medicare and Medicaid Services’ (CMS’) EQR Protocols.
EQR-related activities are intended to:
1. Improve the State’s ability to oversee and manage the managed care plans they contract with for services.
2. Help managed care plans improve their performance with respect to quality, timeliness, and access to care.
In addition, DHCS uses EQR results to inform policies and drive improvements for Medi-Cal Members through statewide quality strategies and with quality assessment and performance improvement efforts across BHPs.
Additional information about Quality of Care EQR , and the 2024 Medicaid and CHIP Managed Care Final Rule, can be found on CMS’ website: www.Medicaid.gov.
FY 2023-24 EQR Reports
Annual Techical Reports
Mental Health
Drug Medi-Cal Organized Delivery System
Performance Improvement Project (PIP) Reports
Mental Health
Drug Medi-Cal Organized Delivery System
BH EQR Reports – DMC-ODS & MH Services
Contact Us
For more information, contact the BH EQRO Unit team at DHCSEQRO@dhcs.ca.gov.
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