HEDIS Measures & Reporting
Guidance on HEDIS behavioral health measures including follow-up after hospitalization, antidepressant medication management, and substance use treatment. Provider-level performance data and improvement resources.
Provider Quality
Quality Improvement
Performance measurement, NCQA accreditation standards, and QAPIP resources for DWIHN network providers committed to delivering effective, person-centered behavioral health care.
HEDIS
Performance Measures
NCQA
Accreditation Standards
QAPIP
Annual Work Plan
QI resources aligned with MDHHS requirements for all active DWIHN network providers.
Quality Framework
Three Pillars of QI
DWIHN quality improvement is built on measurable outcomes, accreditation standards, and a structured annual work plan.
-
HEDIS Performance Measures
Track your performance across HEDIS behavioral health measures. Access measure specifications, data submission guides, and results from DWIHN network reporting.
-
NCQA Accreditation
Resources supporting DWIHN NCQA accreditation requirements that affect network providers — including documentation standards and quality indicator reporting.
-
QAPIP Work Plan
The annual Quality Assessment and Performance Improvement Program work plan outlines DWIHN quality priorities and provider-facing improvement activities.
QI Initiatives
Quality improvement programs and resources
DWIHN supports network providers with comprehensive quality improvement resources aligned with NCQA standards, MDHHS requirements, and evidence-based behavioral health practices.
NCQA Accreditation Support
Support for providers participating in or preparing for NCQA accreditation. Resources on DWIHN quality standards, documentation requirements, and how provider performance connects to DWIHN accreditation.
QI Initiatives & Projects
Collaborative quality improvement projects focusing on care coordination, crisis response, medication adherence, and health equity. Providers may be invited to participate in targeted QI projects based on performance data.
Outcomes & Reporting
Access to outcome reporting tools, member satisfaction data, and performance dashboards. Providers receive regular performance reports with comparisons to DWIHN network benchmarks and state targets.
Our Commitment
Quality Improvement
The staff of Quality Improvement are committed to ensuring the supports and services provided to the people we serve by the Provider Network is one of the highest quality and exceed expectations. The team is responsible for the oversight of the Behavioral Health Care Provider Network System to ensure that Providers are improving the person care experience, advancing the health of the populations we serve, and reducing costs.
-
The Quality Improvement Team is committed to ensuring the supports and services provided to the persons in our community by the provider network is of the highest quality and exceeds our customer expectations.
-
DWIHN will be the benchmark of excellence and value in behavioral health care by providing exemplary services that are both patient-centered and evidence-based.
-
- Customer Focus — Services designed to meet needs and expectations; quality measured by the extent customer desires are met.
- Systems Understanding — Providers must comprehend the service system and key processes to improve them using process engineering tools.
- Teamwork — Essential involvement of process owners in improvement efforts to gain insights, ensure effective implementation, and develop ownership of improved processes.
- Data-Driven Focus — Data analyze processes, identify problems, and measure performance; changes tested and verified for actual improvements.
What We Do
Core QI Functions
-
Handles total quality management and continuous improvement activities, including annual Quality Assessment and Performance Improvement plan development. Facilitates the Quality Improvement Steering Committee (QISC), which oversees quality functions with representation from DWIHN units, providers, consumers, and practitioners.
-
Tracks and evaluates provider-level performance data across HEDIS behavioral health measures, encounter data completeness, timely access standards, and member outcome measures to benchmark against DWIHN network and state targets.
-
Manages compliance monitoring across the entire system. Responsibilities include setting standards, conducting assessments, remote and on-site provider monitoring, facility quality reviews, and provider education. Coordinates MDHHS site visits, corrective action plans, and new program enrollment reviews.
-
Coordinates outside entity reviews, specifically EQR and NCQA accreditation pursuits. Health Services Advisory Group (HSAG) conducts three annual reviews: Compliance Monitoring, Performance Measure (ISCAT) Validation, and Performance Improvement Project (PIP) Validation.
-
- Annual QAPIP plan and report development
- Standard-setting
- Performance assessments
- On-site provider monitoring
- Regulatory and corporate compliance management
- Outside entity review process management
- Research facilitation
- Quality improvement process facilitation
- Provider education and oversight
- Critical incident and sentinel event analysis
Regulatory Compliance
Home and Community-Based Services (HCBS)
In 2014 CMS released the HCBS final rule requiring all settings providing HCBS-funded services to meet specific criteria for continued Medicaid funding. The HCBS provide opportunities for Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings.
Eligible populations include people with intellectual/developmental disabilities, physical disabilities, and/or mental illnesses. The goal is to ensure individuals receive supports enabling independent decision-making, full participation in community life, and respect for their rights.
Service types include community living supports (CLS), skill building, and supported employment services.
HCBS Documents
- Resident Handbook Receipt (DOCX)
- Residential Annual HCBS Site Review Tool (PDF)
- Non-Residential Annual HCBS Site Review Tool (PDF)
MDHHS Resources
HCBS Compliance
All DWIHN network providers of HCBS must meet CMS final rule requirements. Contact QI for guidance on compliance documentation.
Data & Transparency
Reports & Meeting Documents
Reports & Evaluations
-
Documentation and procedures for the mandatory reporting of member deaths per DWIHN and MDHHS requirements.
Download Reference
Meeting Documents
-
Quality Operations Technical Assistance Workgroup — meets 3rd Wednesday monthly.
FY 2025-2026
FY 2024-2025
-
Quality Improvement Steering Committee meeting minutes and agendas.
FY 2025-2026
FY 2024-2025
April L. Siebert
Director of Quality Improvement
April and her team are committed to continuous improvement across every aspect of the behavioral health network. Through data-driven oversight, accreditation standards, and collaborative partnerships with providers, DWIHN ensures that quality care is not an aspiration — it is a measurable, accountable commitment to every person we serve.
Quality is not a destination. It is a daily practice — one our entire network embraces together.
Quality Standards
What DWIHN expects from network providers
All DWIHN network providers are expected to meet quality standards outlined in the Provider Manual and their contract agreements. DWIHN conducts ongoing monitoring of provider performance through claims data, member feedback, and clinical record reviews.
- Timely access to care per MDHHS standards
- Person-centered treatment planning and documentation
- Participation in QI activities and data reporting
- Evidence-based practices for behavioral health services
- Member rights and grievance process compliance
Questions about QI requirements?
Our Quality Improvement team can answer questions about performance measures, reporting requirements, and QI participation expectations.
Contact QI Team