Compromised Controls and Pace of Change Hampered Implementation of Enhanced Mental Health Services (July 2008)

Since 2006, the state has struggled to implement a new array of mental health, developmental disabilities, and substance abuse services. Several factors contributed to implementation problems, including the pace and scope of implementation, insufficient forecasting and monitoring, and lack of information about system performance. The Department of Health and Human Services should collaborate with other stakeholders to re-evaluate what information is needed about system performance, how it is collected, and how it is presented. Additionally, the evaluation recommends focusing analytic efforts within one specific office of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services to ensure consistency, depth, and quality of analysis.

Final Report

Executive Summary



Agency Actions:

  • MHDDSAS provides a quarterly performance report to the Joint Legislative Oversight Committee on Health and Human Services on local management entities’ performance on 21 contracted measures. The MHDDSAS Quality Management Team provides a 12-month overview of service utilization trends to division management. Training and additional reporting have improved client data integrity. The Division of Medical Assistance and MHDDSAS coordinate performance measurement and oversight as part of implementing the 1915b/c Medicaid Waiver project. A planned provider quality report has been replaced with the “Gold Star” provider monitoring and incentive program used by the pilot waiver site (Piedmont Behavioral Health), as required by legislation. Additional activities targeting internal quality improvement include implementation of a MHDDSAS Quality Management committee structure, required quality management expectations for local management entities, and Intra-Departmental Monitoring Teams to oversee each local management entity’s progress and performance in carrying out their responsibilities. In addition, DHHS is currently working on specific performance measures that can be utilized as a dashboard which will have the capacity to implement an incentive payment structure.