Access

• Members with emergent needs who are seen within 6 hours
• Members with urgent needs who are seen within 24 hours
• Members with routine needs who are seen within 10 business days
• Member access to psychological testing
• Average speed of telephone answer (ASA)
• Telephone call abandonment rate

Availability

• Members with appropriate facility availability
• Members with appropriate practitioner availability
• Members with appropriate practitioner ratio 

Care of Members

• Patients admitted for mental illness who complete a follow-up visit within 30 days of hospital discharge
• Patients admitted for Depressive Disorders who complete a follow-up visit within 30 days of hospital discharge
• Patients admitted for detox who complete a follow-up visit within 30 days of hospital discharge
• Patients under 18 years of age who complete one family therapy or evaluation session within 30 days of initial outpatient assessment

Information Management

• Claims: Rate of Provider Claims Payment
• Credentialing and Recredentialing Activities
• Completeness of practitioner treatment records 

Quality Improvement

• Member satisfaction
• Provider satisfaction
• Treatment consistent with Bipolar Disorder Practice Guideline
• Outpatient treatment plans consistent with Depression Practice Guideline

Member Rights and Responsibilities

• Non-certified days overturned on appeal
• Cases with non-certified days resulting in partial or complete overturn on appeal
• Appeal resolution timelines

Risk Management

• Complaints
• Complaint resolution timeliness
• Requests to change provider
• Patient Safety Monitoring
• Sentinel events

Utilization Management

• Inpatient days per 1000 members per year
• Partial hospital visits per 1000 members per year
• Outpatient visits per 1000 members per year
• Average length of hospital stay
• Patients readmitted to inpatient care within 90 days of inpatient discharge
• Readmission episodes within 90 days of inpatient discharge
• Patients readmitted to inpatient care within 30 days of inpatient discharge
• Readmission episodes within 30 days of inpatient discharge
• Pended cases resolved within 24 hours
• Consistency of application of medical necessity criteria (inter-rater reliability) 

Measurement Requirements

• Continuity and coordination of care within behavioral health
• Continuity and coordination with medical care
• Clinical issue identified in collaboration with relevant medical delivery system (Region specific)
• Timeliness of UM decisions
• Clinical information consistently supports UM decisions
• Assessment of preventive health programs
• Quality and utilization improvement program evaluations