The vendor is required to provide will examine both current clinical and legal operations and historical practices from the past three years, focusing on clinical procedures, legal compliance, and risk management systems.
- Documentation review
• Audit of clinical records (random sampling of 15-20% of current and closed cases from the past three years across all service lines), including care coordination, enhanced care coordination, brief therapy, psychological testing, psychiatric medication management, and psychiatric consultation
• Analysis of existing and historical policies and procedures, including those for determining service eligibility and feel-level assignment
• Review of incident reports and complaint logs
• Evaluation of clinical supervision documentation
• Examination of clinician credentialing files
• Review of board minutes related to clinical governance
• Assessment of compliance with key billing and coding requirements for major payers (colorado Medicaid, medicare, and three largest payers in our patient population)
• Assessment of service eligibility practices
b. Systems analysis
• Review of workflow mapping and evaluation of all current clinical workflows and assessment against professional standards
• Assessment of documentation templates against professional standards
• Analysis of protocols for high-risk clinical situations
• Evaluation of current and historical practices for client assessment, enhanced care coordination, brief intervention therapy, psychological testing, medication management, and psychiatric consultation and monitoring against professional standards
• Assessment of referral and transition of care and discharge protocols
• Review of clinical supervision structure and implementation
• Staffing assessment of workload and workflows relative to industry standards
c. Stakeholder assessment
• Confidential interviews with clinical and administrative staff
• Discussions with board members oversight understanding
• Interviews with key community and referral partners (as appropriate)
• Interviews with current and former patients (as appropriate) d. Compliance evaluation
• Assessment against licensing board requirements for each clinical discipline
• Analysis of HIPAA and other federal and state privacy law compliance systems, including cybersecurity and electronic communication systems (text, email, telehealth, etc.), and description of services provided.
• Evaluation of controlled substance prescribing practices, drug voucher use, and pharmaceutical samples storage
• Evaluation of telehealth policies and procedures
• Evaluation of mandated reporting processes
• Review of documentation against legal requirements specific to adult behavioral health
e. High-risk case review
• Analysis of risk assessment processes including crisis intervention protocols and implementation
• Detailed examination of adverse incidents from the past five years
• Review of documentation for high-risk clinical populations
f. Legal vulnerability analysis
• Identification of documentation gaps and patterns
• Assessment of clinical decision-making documentation
• Including analysis of triage practices and documentation of inclusion and exclusion criteria that determine whether patients receive direct treatment, care coordination, or referrals to other providers.
• Evaluation of informed consent processes
• Analysis of release of information practices
• Analysis of case termination practices
• Review of caseload distribution and management.
- Contract Period/Term: 2 years
- Questions/Inquires Deadline: March 21, 2025