PERFORMANCE OUTCOME MANAGEMENT SYSTEM (POMS) INITIAL CONSUMER REGISTRATION

The primary purpose of the POMS data collection is to serve as the basis for producing a set of performance measures/indicators for the BH-MCOs. The POMS serves the following functions:

1. Provides accountability for public funds expended through the Department’s capitation payments to the BH-MCO contractors.
2. Provides a fair and objective evaluation of the BH-MCOs that the Department can use for implementing outcome oriented incentives and sanctions.
3. Supports the Department and the BH-MCO contractors to implement a collaborative Continuous Quality Improvement process.
4. Provides outcome data to support the necessity and validity of the behavioral health carve-out.

Providers are required to report to VBH-PA data about psychiatric consumers in the HealthChoices program via two reporting forms, the “Consumer Registration Form” and the “Quarterly Status Update Form”. POMS data may also be submitted using ProviderConnect, under “Specific Member Search.” ProviderConnect is available online at www.vbh-pa.com/providers.htm.

For completion of the POMS data reporting forms, please follow these instructions:

• The forms pertain to Mental Health Services only. If you are providing services as a licensed Drug & Alcohol provider, please refer to the Bureau of Drug & Alcohol Programs process for POMS reporting.
• If you are providing services as an inpatient provider, VBH-PA will complete POMS reporting as part of the assessment process.
• The Consumer Registration Form (CRF) is used when opening a new plan of care. If the member has received services from a HealthChoices provider within the last six months, a CRF report should already be on file. If you are uncertain as a provider as to whether this has occurred, please submit a form and VBH-PA will address this internally.
• After completing the CRF form, if the member does not present as one of the priority populations (03 – Adult Target Population #1, 04 – Adult Target Population #2, 54 – Child & Adolescent Target Population #1, 55 – Child & Adolescent Target Population #2) no future forms need to be completed unless the member’s status changes to a reportable priority population type or until the case is closed. When a case is closed, a CRF form indicating the date of closure needs to be faxed to VBH-PA.

A Quick Guide for POMS has been developed to answer your questions regarding the POMS reporting. If you need further assistance please call the toll-free provider line at 877-615-8503 and someone will assist you.