Monitoring

The Contract Performance Unit of Vaya Health assures that the provision of service to our members meets the highest standard of quality, while also working collaboratively with our Provider Network.

MCOs are required by statute (NC GS § 122C-111) to monitor public mental health, intellectual/developmental disability and substance abuse services. Types of monitoring conducted by the Contract Performance Unit of Vaya Health are listed below. Any provider offering services to Vaya Health members is subject to monitoring.

Types of Monitoring:

Vaya Health conducts multiple types of provider monitoring activities.  For your reference, tools for specific reviews are listed below.

Investigations-Focused Monitoring/Complaint Investigations

Targeted and time-sensitive investigations that assess quality of care, health and safety issues, and service definition compliance

Emergency Health and Safety Reviews

A review that is conducted immediately to assess the health and safety of our members

Routine Monitoring

A review conducted at a minimum of every two years for Licensed Independent Practitioners (LIP) and all provider agencies that are not licensed by the Division of Health Service Regulation (DHSR) or are licensed by DHSR but not monitored annually (ex. PSR, Day Treatment, SAIOP, and SACOT etc.). Routine monitoring may entail a routine monitoring tool and a post-payment review tool, or a post-payment review tool alone. Only the post-payment review tool is completed for providers of services in licensed facilities monitored annually by DHSR.

The Routine Monitoring Tools are available below:

Unlicensed AFL Reviews

An annual health and safety review of unlicensed community based private homes.

DHHS Unlicensed AFL Review Tool

Vaya Health AFL Home Add and Change Form

AFL new email address: AFL.info@vayahealth.com

Unlicensed Site Reviews

A health and safety site review that is conducted during initial enrollment and re-credentialing of Contract Providers. Site reviews are also conducted when a Contract Provider adds a new site.

DHHS New Unlicensed Site Review Tool

Federal Block Grant Reviews

The Block Grant Review is conducted annually to ensure compliance with the requirements of 45 CFR Part 96, Subpart I, the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and of 42 USC Part B, Subpart I, Block Grants for Community Mental Health Services (CMHBG). Block Grant monitoring consists of a review of multiple programs. It also includes record reviews for specific service requirements.

Fiscal Year 2016 Guidelines

NC-TOPPS

Vaya Health providers are required to participate in the NC-TOPPS system as outlined by the NC-TOPPS guidelines.  NC-TOPPS interviews collect vital information about the people served by the North Carolina mental health and substance use system.  Vaya Health providers are expected to maintain a 90% compliance rating on submission of NC-TOPPS interviews as outlined on the NC-TOPPS Website.

Please note that investigations, routine monitorings and other monitoring activities could result in a Plan of Correction and/or a referral to the Special Investigations Unit.

Call 1-800-849-6127 toll free 24/7 to access mental health, substance use and intellectual and/or developmental disability services. Members can request materials in Spanish or English.

Llamar al número gratuito 1-800-849-6127 24/7 para obtener servicios y apoyo a la salud mental, discapacidades de desarrollo y abuso de sustancias. Los miembros pueden solicitar materiales en español o Inglés.