Provider Manual - Show Me Healthy Women (SMHW)

The CDC evaluates the SMHW program’s ability to meet established core program performance indicators. Performance indicators are evaluated from the Minimum Data Elements (MDEs) submitted by DHSS every October and April. MDEs are standardized data elements that provide consistent information on patient demographics, screening results, education, diagnostic procedures, and treatment information. Collect MDEs on women screened and/or diagnosed with program funds. Obtain MDE data from the history, assessment, screening, and diagnostic reports entered into the MOHSAIC system.

SMHW Core Program Performance Indicators

Quality Assurance

The goal of the Quality Assurance (QA) program component is to ensure that appropriate services are provided to each client and that program funds are utilized as required by program protocols. QA activities ensure high-quality medical standards of care are provided to women receiving SMHW and WISEWOMAN screenings, diagnostic and education services, as well as referrals for treatment when appropriate.

DHSS monitors and evaluates the quality and appropriateness of client care using the following QA activities:

• Incorporating data edits in the MOHSAIC electronic reporting system that limit the reporting of inappropriate and inaccurate client service records.
• Reviewing electronically submitted client service reports for compliance to standards of care prior to approval for reimbursement.
• Tracking alert values (abnormal testing results) to ensure clients receive appropriate diagnostic services and access to treatment, if needed.
• Performing initial on-site QA monitoring at each new SMHW and WISEWOMAN provider six months after first client is served and every two years thereafter. Scheduled QA monitoring occurs at any time deemed necessary by DHSS staff because of questionable reports (page 8.5).
• Providing training and technical assistance to providers to improve quality of care based on results of QA monitoring.
• Evaluating client and provider expectations.

Quality Assurance Follow-up

At the time of the provider’s on-site review, technical assistance is provided by the RPC to clarify or demonstrate any points of confusion. After the on-site review, follow up with a post-review letter describing any areas needing improvement. Follow-up may be conducted to review success in instituting the recommended improvements. If the RPC determines a provider has consistently not met the program's clinical standards, the provider is asked to complete a corrective action plan. Typically, the RPC conducts another review in six (6) months to ensure implementation of the corrective plan and the provider is working to resolve the problem.

Quality Assurance Provider Expectations

QA monitoring will monitor providers’ compliance with the following expectations:

Client Rights

• Privacy
• Confidentiality
• Access to test results
• Follow-up of medical problems through referrals, diagnosis and treatment
• Client will not be held financially responsible if identified as a SMHW client
• Access to an interpreter
• Treatment per Civil Rights Act
• Treatment per Americans with Disabilities Act

Intake and Eligibility Guidelines

• Staff knowledge of SMHW/WISEWOMAN eligibility guidelines
• Procedure to screen and identify clients
• Annual review of clients for continued eligibility

Screening and Diagnostic Protocols

• Screening includes pelvic exam, pap test, CBE, and mammogram, if appropriate
• Standards and protocols for follow-up

• Procedure to track clients with abnormal results, including:

  • Name of client
  • Test
  • Date test completed or missed appointments rescheduled
  • Results and that client is notified of results
  • Referrals including tracking that appointments were kept or rescheduled
  • Follow-up visit dates, if needed
  • Documentation of complete Plan of Care/Treatment to include facility, treatment start dates and treatment type
  • Disposition of client status regarding follow-up, refusals of treatment or diagnostic testing recommended. Report to the RPC problems with missed appointments, lost to follow-up or refusals, promptly

   

Clinic Management

• Staff is trained and familiar with provider guidelines
• Policy and procedures are in place for billing and filing forms
• Procedure to track amount of program funds is in place
• Maintain professionally licensed or certified staff to perform program activities
• Notify SMHW Central Office including RPC of staffing changes promptly regarding the need for provider or rescinding clinic staff MOHSAIC access and to schedule SMHW training for new hires
• Track clients who receive screening and diagnostic results to provide complete case management from the initiation of care to the end of the plan of care
• If missed appointments or refusals of follow-up recommendations occur, make attempts to contact the client to reschedule and let the RPC know about situations regarding missed or refused follow-up
• The facility is clean with appropriate space for screening
• There is an in-house plan for quality checks at regular intervals
• Provide Navigation Services for women who have not been screened:
  • A minimum of two documented client visits, and
  • A completed navigation form in the record is required.

SMHW Quality Assurance Form

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