State of Alaska Division of Legislative Audit

Behavioral Health Improving Administrative Functions Recommendations Table

Recommendation NumberRecommendation
1.2.3Reorientation of the order of information on the budget visualization would improve communication of budget details.
1.2.5The use of visual aids in the Governor’s Amended Budget, such as bar graphs and tables, assists readers in comprehending and understanding the information presented. These could be further improved by standardizing the timelines used on these visual elements.
1.2.6The presentation of Department challenges and accomplishments in the Governor’s Amended Budget would be improved with a discussion of solutions, as well as an assessment of whether accomplishments meet Department goals.
1.2.7The Governor’s Amended Budget could be improved through the inclusion of an introduction and description of programs for each Results Delivery Unit (RDU) that would orient the reader to the detailed information that follows. The inclusion of historical and projection data would also facilitate evaluation of program elements over time.
2.4.1Reforming staffing policies and practices at API, including more competitive hiring and retention efforts, could significantly improve the quantity and quality of care without increasing costs.
3.0.3The Department should continue to promote greater capacity and utilization of peer support services.
3.0.8The Department should develop a Medicaid behavioral health rate structure that covers provider costs, incentivizes quality, and minimizes administrative burden.
4.3.1The Department should distinguish more clearly between measures of Division activities and the activities of funded providers.
4.3.2The Department should develop a consistent approach to measuring behavioral health performance across divisions.
4.3.3The Department should ensure continuity among program, division, and departmental-level evaluation of services, with appropriate degree of specificity and generality.
4.3.4The Department should incorporate performance measures that are more appropriately outcome-oriented.
4.3.5The Department should incorporate nationally recognized behavioral health treatment and recovery measures into the Department’s performance measurement strategy.
4.3.6The Department should align performance measurement of community providers, as far as possible, with measures used in accreditation requirements.
5.5.1The Department should implement a consistent and interoperable information technology solution for referrals across the behavioral health continuum of care.
5.5.5The Department should provide regional hospitals with a consistent screening tool and mapped interventions for individuals presenting with behavioral health-related emergencies.
5.5.6The Department should implement the recommendations presented in the State’s Recidivism Reduction Plan.
6.4.2The consolidation of grant and Medicaid review responsibilities can reduce costs and administrative burden on providers, but only if reorganization does not conflict with Medicaid administrative claiming processes or dilute the Department’s regulatory role.
8.3.2The Department should prioritize development of interoperability of data for all recipients of behavioral health services, from SDS to DBH to OCS.
8.3.3In the near term, the Department should transition all behavioral health providers across the continuum of care to data reporting through AKAIMS.
8.3.4The Department should develop clear and consistent priorities for data collection and incorporate these into the Minimum Data Set in AKAIMS.
8.3.5The Department should integrate AKAIMS and API data to the greatest extent possible.
8.3.6The Department should prioritize implementation of an accurate and complete Master Client Index.
9.3.4The Department should consider revising Medicaid regulations to increase non-grantee, private provider participation in Medicaid.
9.3.7Although the Department has produced user training videos for GEMS that have been praised by the provider community, it should also consider a user manual to accompany training videos to support instruction in rural communities with limited internet bandwidth.
9.4.3The Department should provide comprehensive training to all Division of Behavioral Health employees acting as grant and contract managers.
9.4.4The Department should improve the year-end report to focus more strongly on outcomes and performance metrics as opposed simply to dollar amounts or tasks accomplished.
9.5.3The Department should include a simple dashboard into the GEMS program that visually tracks program goals and percent completion. Although tracking for some qualitative measures may be difficulty, simple graphics demonstrating percent completion are useful in helping grantees to remain on track.
9.5.8The Department should review the grant management process to ensure that grant administrative burden is commensurate with the size of the grant award.
12.2.2The Department should develop a consistent and transparent data analysis and reporting system, accessible throughout the Department that illustrates regular, monthly performance trends without reliance on ad hoc reporting.
12.2.3The Department should implement a uniform utilization reporting structure across the behavioral health continuum of care.
13.2.1The Department should strengthen Medicaid provider enrollment activities by requiring enrollment of all rendering provider types.
13.2.3The Department should streamline audit and investigation processes for providers by focusing resources on provider types that pose the greatest risk of overpayment, reducing audit cycle time and improving communication on audit status, and seeking a waiver of certain federal audit requirements.