Risk & Quality Management Team: Medicaid Compliance Unit (MCU)

Annual Medicaid compliance score from External Quality Review Organization

96%2021

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Partners
  • Department of Aging and Independent Living (DAIL)
  • Vermont Department of Health (VDH)
  • Department of Mental Health (DMH)
  • Department of Children and Families (DCF)
  • Agency of Human Services Central Office (AHS CO)
Story Behind the Curve

This performance measure is important because it gives us an independent assessment of our compliance with key Medicaid managed care laws as well as our Intra Governmental Agreement (IGA) with AHS. These auditors review Medicaid Managed Care models across the country, so their perspective and findings are very helpful to us as we continuously look for ways to improve our Medicaid system.

The External Quality Review Organization (EQRO) audit is conducted annually, but there are three different groups of standards. The audit focuses on one group of standards per year on a three-year cycle. Some audit years have more difficult standards. The audit scores demonstrate not only our compliance with standards, but also our commitment to improving our compliance program.

Close collaboration with our partners has been the most effective strategy for keeping our compliance scores high. The audit covers topics that go beyond DVHA’s direct responsibilities, so each standard requires cooperation from partnering departments and the AHS Central Office.

Overall, the data show our general success with meeting our goal of staying above 90% with our annual score.

Narrative last updated:  02/02/22

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy