Newsletter Article

CalMHSA Assists Counties With HEDIS Measure Calculations  

Key staff: Dawn Kaiser, LCSW, CPHQ, Senior Director Managed Care Operations    

Counties can now turn to CalMHSA for assistance calculating their behavioral health Healthcare Effectiveness Data and Information Set (HEDIS) measures — required by the Department of Health Care Services (DHCS) — including the first reporting tentatively  due in April 2024.  DHCS has issued nine priority behavioral health HEDIS measures as part of its Comprehensive Quality Strategy, with the goals of measuring both effectiveness and access/availability of care.  

CalMHSA is coordinating with DHCS and the California External Quality Review Organization (CalEQRO) to determine the concrete timelines and deliverables.    

Recognizing that counties may not have the capacity to respond to this new requirement, CalMHSA has developed a new program that will use data from counties’ service claims, plan data feeds and Medi-Cal eligibility files to:  

• Calculate the HEDIS measures (provide numerator/denominator and performance rate ) 
• For counties that run Mental Health Plans and DMC-ODS Plans, this will include an annual calculation of nine HEDIS measures.  
• For counties that run Mental Health Plans and Drug Medi-Cal State Plans, this will include an annual calculation of five measures. 

Counties participating in the Partnership Health Plan of California (PHC) DMC-ODS Regional Model should contact PHC to confirm that PHC will calculate the DMC-ODS measures on behalf of the county plans. 

 A recording of a webinar CalMHSA hosted earlier this month helps to explain the HEDIS reporting and new program scope of work, including additional information on priority measure definitions, reporting timelines and requirements, key considerations, and Participation Agreement details.  

  For additional information, contact [email protected].  

February 23, 2024