City of Philadelphia
Quality Management and Compliance (QMaC)
The QMaC Unit is committed to adapting to an increasingly complex environment and to proactively minimizing Departmental vulnerabilities and risks.
The unit works to establish the structure and processes necessary to define, measure, and improve the quality of services delivered to the individuals we serve while monitoring compliance with federal and state laws and regulations, as well as Departmental policies, procedures, and requirements.
Originally established as the Quality Managed Unit in 2019, the unit was renamed in 2023 to reflect its expanded scope of responsibilities. The unit initially consisted of the Project Management Team, later incorporating CBH oversight functions in 2020, absorbing the NIAC team in 2021, and ultimately developing the DBHIDS Compliance Program, creating the need for a fourth team.
There are four focus areas within the QMaC unit:
Project Management and Quality Assurance
The Project Management and Quality Assurance team supports the implementation and monitoring of:
- Project management tools and technical support.
- System management.
- Quality assurance of system management activities.
- Development and maintenance of some intranet resources.
This team manages projects across the QMaC unit with a focus on supporting key business areas such as Compliance, NIAC, and CBH Oversight. Its work also extends to cross-division partnerships and sustainability initiatives that drive long-term operational impact.
By applying a structured project management framework, the team guides data-driven decision-making and facilitates the implementation of process improvements.
Continuous quality assurance activities ensure system alignment, identify opportunities for enhancement, and promote consistency across Departmental processes.
Community Behavioral Health Oversight
Under the Pa. Department of Human Services, the Office of Mental Health and Substance Abuse Services (OMHSAS) is the governing body for Pennsylvania’s behavioral health services. OMHSAS requires counties to manage the provision of quality behavioral health services, assigning this responsibility to the primary contractor (PC).
DBHIDS serves as the PC for Philadelphia County. Within DBHIDS, the CBH Oversight team under the QMaC unit carries out this responsibility. In this role, the CBH Oversight Team monitors the ongoing compliance of Community Behavioral Health, the Behavioral Health Managed Care Organization for Philadelphia County, with the work statement tasks, standards, and requirements established by the Pa. HealthChoices Behavioral Health Program Standards and Requirements and its appendices, Program Evaluation Performance Summary, CBH’s policies and procedures, federal and state regulations, and best practices.
CBH Oversight activities are overseen by OMHSAS’ Bureau of Quality Management and Data Review. The CBH Oversight team ensures CBH complies with OMHSAS’ HealthChoices Behavioral Health Program Standards and Requirements through structured tracking and monitoring activities.
The team’s duties are focused in the following key areas:
- OMHSAS Deliverables and Reporting: Preparation, submission, and ongoing oversight of required deliverables to OMHSAS including monthly, quarterly, and annual reports; policy and procedure revisions; and quarterly data tracking activities.
- Monthly Audits: Oversight of CBH’s denials, complaints, grievances, external reviews, fair hearings, clinical care management documentation, and member and provider quality of care concerns. A comprehensive monthly report is produced to identify trends, areas of concern, and opportunities for improvement.
- Triennial Review: The Triennial Review is OMHSAS’ opportunity to audit CBH and the Philadelphia County Primary Contractor to evaluate performance and alignment with the HealthChoices Behavioral Health Performance Standards and Requirements and provides DBHIDS and CBH with an opportunity to implement OMHSAS recommendations for improvement.
Network Improvement and Accountability Collaborative (NIAC)
The Network Improvement and Accountability Collaborative (NIAC) monitors Philadelphia County providers’ implementation of the Network Inclusion Criteria (NIC) practices. The provider network also includes Pennsylvania Department of Drug and Alcohol Programs (DDAP) and Single County Authority (SCA) providers. DBHIDS views the pursuit of excellence as a shared responsibility among all stakeholders, including external entities, provider agencies, DBHIDS staff, individuals seeking and receiving services, and the community at large. Grounded in the Practice Guidelines and operationalized through the NIC, this collaborative approach is critical in shaping future practices.
NIAC’s primary purpose is to create and sustain a high-quality network of care. To achieve this goal, NIAC uses a comprehensive and objective scoring tool to evaluate the extent to which providers align with the principles outlined in the DBHIDS Practice Guidelines, Departmental initiatives, priorities, and Compliance Program requirements.
This effort is guided by a vision that emphasizes:
- Ongoing improvement in the quality of care provided to individuals receiving services.
- A shared accountability partnership among DBHIDS, providers, individuals receiving services, and other stakeholders, designed to:
- Identify strengths and challenges in provider performance through multiple methods including data analysis; direct observation; interviews with individuals receiving services, family members, and staff; and review of information gathered within the service delivery environment.
- Identify providers demonstrating exceptional practice.
- Provide targeted support to providers with identified areas requiring improvement.
Key domains assessed during a NIAC site review include:
- Foundations of Excellence in Service Delivery
- Creating excellence in agency staffing and development.
- Conducting supervision in a recovery/resilience-oriented environment.
- Determining quality of care and outcomes.
- Domain One: Assertive Outreach and Initial Engagement
- Promoting easy access and responsive engagement.
- Facilitating early intervention.
- Domain Two: Screening, Assessment, Service Planning and Service Delivery
- Conducting strength-based assessments and evaluations
- Conducting high-risk behavioral assessments (urgent screening).
- Advancing excellence in resilience and recovery-oriented service planning and delivery.
- Ensuring safe and effective medication practices
- Domain Three: Continuing Support and Early Reintervention
- Embracing comprehensive continuing support.
- Domain Four: Community Connection and Mobilization
- Energizing children, youth, and adult peer culture, support, and leadership.
- Strengthening community inclusion and mobilization.
- Integrating physical and behavioral health care.
DBHIDS Compliance Program
The purpose of the DBHIDS Compliance Program is to ensure providers, programs, operations, and services maintain the highest ethical standards, comply with all local, state, and federal laws and regulations, and demonstrate financial responsibility in the delivery of contacted services.