The Managed Behavioral Health Organization Primer-OnDemand
Course Type: Self-paced
Recorded Date(s): 02/28/23-03/02/23
Recording Duration: Approximately 2.5 hours
Course Expire Date: 02/28/24
The Managed Behavioral Healthcare Organization (MBHO) Accreditation Primer
Increasingly, behavioral health care plays a key role in the growing need to deliver care that incorporates medical, behavioral and social risk factors. As the need for behavioral health care grows, so too does the need to discern the value of organizations that manage the provision of this care. NCQA’s Managed Behavioral Healthcare Organization (MBHO) Accreditation provides a powerful way to demonstrate the value of a MBHO to health plans, employers, regulators and consumers and its commitment to follow evidence-based practices to ensure the provision of the best possible care. By laying out a roadmap for improvement, the NCQA MBHO Accreditation standards help organizations implement industry best practices to provide high-quality care, access, and consumer protections.
Throughout this training, NCQA will provide a Standard-by-Standard review of requirements for the NCQA MBHO Accreditation. Through these sessions, faculty provide insight into understanding NCQA’s requirements, navigating the standards, and avoiding pitfalls. In addition to answering live questions from participants, faculty will address scenarios and examples based on performance improvement opportunities from prior NCQA surveys.
- Credentialing and Recredentialing
- Member Rights and Responsibilities
- Utilization Management
- Quality Improvement
Note that Delegation is covered in a separate course.
The purpose of this course is to support the planning and sustainability of performance excellence by providing participants with practical guidance for navigating MBHO accreditation standards. To optimize the learning experience, each participant is afforded the following resources:
- Presentation slides.
- Recording of live session.
- Live Q&A.
- Scenarios for applied learning.
- Expert/ NCQA surveyor perspective of the standards.
- IPCE Credits for physicians, nurses, and pharmacists.
- Health providers that offer behavioral health services, including:
- Practitioners, clinicians, and staff who serve Medicaid populations.
- Community Mental Health Clinical (CMHC) staff.
- Licensed Clinical Social Workers (LCSW).
- Purchasers of MBHO services such as health plan and state Medicaid agency staff
- Staff involved in the preparation for MBHO Accreditation Survey.
- Interpret the intent of NCQA MBHO Accreditation standards.
- Describe relationships and themes across standards for Care Coordination, Credentialing, Member Rights & Responsibilities, Utilization Management, and Quality Improvement.
- Recognize requirement implications for members/ patients, staff, partners, and other stakeholders.
- Define opportunities for quality improvement and performance sustainability.
By achieving these learning objectives, participants may experience the following operational efficacies as three-to-nine-month post-participation outcomes:
- Increased productivity in prioritizing and planning interventions.
- Improved practices in monitoring issues and risks.
- Enhanced coordination in cross-functional efforts.
- Refined tactics in monitoring performance.
- Better understanding of best practices to prepare MBHO Accreditation Survey documentation.
Catherine Gitimu, MBA, MS
Catherine Gitimu has extensive knowledge of National Committee for Quality Assurance (NCQA) Accreditation standards and survey processes. Her areas of expertise include Health equity, quality management and improvement, credentialing, member experience, delegation, utilization management, case management, physician and hospital quality and compliance with Accreditation standards, including NCQA standards for health plans, MBHOs, UM organizations, CM organizations and CVOs.
Ms. Gitimu is an Independent Contractor serving in the following capacities.
Senior Consultant with The Mihalik Group, LLC. Ms. Gitimu provides consultative services to organizations seeking NCQA Accreditation. She conducts NCQA survey readiness assessment for organizations that are new to NCQA Accreditation. She conducts gap analysis to identify areas where organizations meet and do not meet NCQA requirements. She provides customized solutions to address identified gaps. She guides organizations through the NCQA survey process and prepares them for a successful survey experience. She designs and delivers customized trainings to organizations interested in any NCQA Accreditation program.
NCQA Surveyor. Ms. Gitimu is an administrative surveyor and trainer for Accreditation Programs. She is a reviewer for Special Needs Plans. She is a reviewer for other programs (e.g., North Carolina Care Management Agency AMH+/CMA Certification Program).
Consultant for health plans. Ms. Gitimu provides tailored solutions to complex accreditation scenarios for organizations’ first NCQA accreditation or re-accreditation surveys.
Ms. Gitimu was previously Senior Manager of Accreditation Policy for NCQA. In this role, she managed the annual development and publication of NCQA Accreditation standards and guidelines for many of NCQA’s products. She prepared and presented proposed standards’ changes to NCQA’s Standards Committee, analyzed public comment feedback and incorporated changes to appropriate standards and guidelines. She resolved complex onsite file review issues from surveyors in real time, provided expert opinion on standards interpretation, and worked with NCQA’s sales team to help prospective customers with the survey prequalification process and with the Accreditation Operations team to improve survey processes. She was faculty for NCQA seminars, NCQA surveyor training and the NCQA Speakers Bureau on Health Plan Accreditation, credentialing standards, UM standards and delegation standards, and was also an administrative surveyor.
Ms. Gitimu earned her BS in Agricultural Science from the University of Nairobi, her MS in Information Management from Sheffield University, her MBA from The George Washington University and her Diversity, Equity, and Inclusion in the Workplace Certificate from University of South Florida.
Matthew Keats, MD, MMM
Dr. Keats currently holds the position of Assistant Profession of Clinical Psychiatry at the Eastern Virginia Medical School and also serves as a Senior Consultant with The Mihalik Group.
Previously, he was the first Behavioral Health Medical Director for Virginia’s Department of Medical Assistance Services (DMAS), where he helped lead the organizations’ Behavioral Health transformation effort and provided medical leadership to DMAS’s ARTS (Addiction Recovery and Treatment Services) program.
Dr. Keats also served from 2013 to 2017 as the Behavioral Health Medical Director of Anthem Health Keeper’s Plus and from 2012 to 2013 as the Medical Director and Vice President with Ameritox, a Baltimore based company specializing in medication monitoring solutions. From 2008 to 2012, Dr. Keats was Medical Director at Optima Health Plan, a division of Sentara Health Care, an integrated delivery system based in Hampton Roads, Virginia, overseeing both medical and pharmacy utilization, formulary development, and HEDIS performance improvement.
An NCQA surveyor since 1999, Dr. Keats is also a member of NCQA’s Review Oversight Committee (ROC) and a frequent lecturer for NCQA courses on HEDIS and other topics.
Dr. Keats is a graduate of the University of Virginia School of Medicine and completed his residency in Psychiatry at the Westchester Division of New York Hospital, Cornell Medical Center. In 2002, Dr. Keats completed the requirements for the Master of Medical Management degree from the Tulane University School of Public Health and Tropical Medicine.
Katie Stauffer, MHA
Katie Stauffer is Assistant Director, Product Management, at NCQA, where she is responsible for new product discovery. In this role, she leads the team to identify opportunities for NCQA programs, to address the growing need in behavioral health and help achieve NCQA’s mission to enable better health care, better choices and better health for the whole person.
Previous to her position at NCQA, Ms. Stauffer was Product Manager at the National Quality Forum (NQF). Her work at NQF gave her the opportunity to dive into quality measurement and improvement, working with stakeholders across the health care spectrum to identify opportunities for NQF products and services.
Ms. Stauffer holds a BA in Spanish from the University of Texas at Austin and an MHA from the University of North Carolina’s Gillings School of Public Health.
In support of improving patient care, the National Committee for Quality Assurance is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC) to provide Interprofessional Continuing Education for the healthcare team.
This activity was planned by and for the healthcare team, and learners will receive 7.25 Interprofessional Continuing Education (IPCE) credit for learning and change.
This educational activity is approved for: 7.25 AMA PRA Category 1 CreditTM.
This educational activity is approved for 7.25 nursing contact hours.*
This live course grants 5.0 Continuing Education Unit (CEU) points for PCMH Certified Content Experts.
* Please note – You must attend the entire program to be eligible for total number of contact hours.
Disclosure of Relevant Financial Relationships
The National Committee for Quality Assurance (NCQA) endorses the Standards of the Accreditation Council for Continuing Medical Education which specify that sponsors of continuing medical education activities and presenters at and planners for these activities disclose any relevant financial relationships either party might have with commercial companies whose products or services are discussed in educational presentations.
For sponsors, relevant financial relationships include large research grants, institutional agreements for joint initiatives, substantial gifts, or other relationships that benefit the institution. For presenters or planning committee members, relevant financial relationships include the receipt of research grants from a commercial company, consultancies, honoraria, travel, or other benefits, or having a self-managed equity interest in a company; or having an immediate family member or partner with such a relationship.
Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation.
Relevant financial relationships exist with the following companies/organizations:
Catherine Gitimu: None
Matthew Keats, MD: None
Kaite Stauffer, MHA: None
Additional Planning Committee Member:
Felicia Khaalid: None
Vince Pereira: None
This program was developed in part by NCQA staff.
This program received no commercial support.
- 7.25 AMA PRA Category 1 Credit™
- 7.25 ANCC
- 7.25 IPCE
- 1.00 Participation
- 5.00 PCMH CCE