1	Clinical Quality Review Team (CQRT) Manual A Guide to the Authorization Process for Alameda County Behavioral Health Plan Child and Youth Clients
2	The CQRT process: Is required for services to be authorized for Medi-Cal reimbursement Does not eliminate audit risk but assists the provider in reducing risk of audit disallowances Is not a substitute for a provider’s internal Quality Assurance (QA) process Is Behavioral Health Care Service’s QA process. The California Department of Mental Health has the ultimate authority regarding Medi-Cal audits.
3	CQRT The purpose of the Children’s Mental Health Services Clinical/ Quality Review is to provide a mechanism to review medical necessity, service necessity, quality review, and authorization. The procedures established are in accordance with the Alameda County Behavioral Health Plan standards and policies as established by the Office of Quality Assurance. The Children’s CQRT committees meet a minimum of one time per month representing the Children’s Outpatient, Day Treatment and Outpatient EPSDT Expansion Programs.
4	The Clinical Quality Review Teams will: meet to review charts for Clinical Review and Quality Review as required by the ACBHP standards and policies and the California Department of Mental Health assure ongoing medical and service necessity approve the continuation of services review the chart to ensure that adequate treatment and discharge planning are documented
5	"Fifteen percent (15%)..." Fifteen percent (15%) of all charts presented at each CQRT meeting will be randomly chosen for Quality Review.
6	CQRT Members are: The CQRT Chairpersons who are BHCS supervisors and staff Trained provider agency supervisors or their designees, who are authorized to represent their agency in the CQRT meeting as well as provide their agency staff with feedback regarding Quality Assurance requirements, issues, concerns, or compliments given by the CQRT Licensed, waivered, or registered intern,Licensed Practioners of the Healing Arts (LPHA) who have attended training or orientation regarding CQRT
7	Schedule for Treatment Chart Review Charts are reviewed by the CQRT based on the date of the case episode opening. The review cycle begins on the first of the month in which the episode was opened.* Outpatient and Rehabilitative Day Treatment charts are reviewed every six months. Day Treatment Intensive charts are reviewed every three months. The CQRT review cycles will always remain the same. MHS Report 485 notifies providers that the UC Authorization is expiring and due for a reauthorization
8	Chart to Provider Ratio One agency representative must attend for every 10 charts brought to the committee (i.e. 11-20 charts=two agency representatives, 21-30 charts= three agency representatives, etc.) Any exception to this ratio requires advanced approval from the CQRT Chairperson.
9	The CQRT Meeting Arrive at least 5 minutes before the start time. Representatives arriving 15 minutes or more after the scheduled meeting time, will be told to bring their charts to the next scheduled CQRT meeting for review; this may also result in costly unauthorized services. All agency representatives must plan to stay until ALL charts have been reviewed. Agency representatives are to receive training and orientation to the CQRT procedures by their agency staff prior to their actual participation in the CQRT meeting
10	The Beginning Sign in Give the completed agency CQRT Minute sheet to the chairperson Place charts on the review table Agency representatives are not permitted to review charts from their agency
11	The Middle: Reviewing charts Quality Review charts (marked by post-its) are reviewed first Clinical Review charts are reviewed second Reviewers complete the CQRT form and recommend approval or request a 30 day return The CQRT form is signed by the Chairperson The CQRT form is duplicated and the chart is returned to the provider with a form copy
12	The End: Checking out After ALL charts have been reviewed, providers may leave with: A copy of the CQRT Attendance Sheet Copies of their CQRT Review Request forms A copy of their agency Clinical/Quality Meeting Minutes with dispositions for each chart A copy of the Quality Review Minutes Their charts
13	CQRT form exercise-15 minutes Break into groups of 5, preferably not with your agency staff Refer to page 8 of the CQRT manual for a guide to completing the form Using the CQRT form and vignette provided, complete the form as group Return to the larger group to share the vignette and form completion
14	Guide to Chart Content for CQRT Charts must contain all of the elements required by Medi-Cal Documentation Guidelines (summarized on beginning on page 9 of the Children’s CQRT Manual)
15	Clinical Review The Clinical Review establishes continuing Medical Necessity and Service Necessity Is there a Treatment Plan, included diagnosis and corresponding Progress Notes? Are there indications of progress being made toward the goals? Does the CQRT Review form contain reasons for continuing treatment? Is there an appropriate discharge plan on the CQRT form? Are signatures, dates, Community Function Evaluations, Beneficiary Problem Resolution, Freedom of Choice and HIPPA forms are present?
16	Quality Review A Quality Review is a more comprehensive of the chart The chart is reviewed using the Regulatory Compliance checklist on the back of the CQRT Review Request Form It includes a Clinical Review There should be continuity between the treatment plan and the treatment provided documented in the progress notes
17	Deficient charts are given a 30 day authorization and must be corrected prior to return, if there are: Missing signatures Medical and Service Necessity is not met Missing progress notes Quality Review items are missing Documentation standards are questionable Required forms are absent Documentation is illegible
18	"Charts that do not meet..." Charts that do not meet CQRT charting standards will: 1) be provisionally approved for 30 days 2) be returned to the CQRT meeting with all corrections made 3) and receive a quality review.
19	Meeting Schedules CQRT meetings are organized by the type of provider or primary treatment mode. Meeting assignment is determined by the ACBHP Schedules will be posted on the BHCS web page at http://bhcs.co.alameda.ca.us/ and distributed by the respective Chairpersons Contact Alameda County QA Department if you are uncertain which CQRT meeting you are assigned
20	Final CQRT Advice Read the manual. It covers all aspects of the CQRT process. Train and familiarize your staffs with the CQRT process. Develop a written agency QA Policy & Procedure that all staff must follow. Supervisors reviewing charts and returning to staff for correction prior to the CQRT meeting will reduce deficiencies and the need for time consuming 30 day returns
21	Questions and Answers Medical Records Documentation The CQRT Process
22	Post training questions Quality Assurance and Medical Documentation Standards Damon Bennett, Quality Assurance Associate 567-8114 BennettD@bhcs.mail.co.alameda.ca.us Children’s CQRT Manual Ellen Muir, Chief of CSS, 268-7941 muir@bhcs.mail.co.alameda.ca.us