Medical Record and Facility Site Reviews
HPSM conducts Site Reviews to ensure that all primary care provider (PCP) sites are in compliance of the standards of the California Department of Health Care Services (DHCS)/Managed Care Quality and Monitoring Division (MCQMD).
All participating PCP sites must undergo initial site review upon contracting with HPSM, and at least every three years thereafter per DHCS guidelines and as part of the re-credentialing process, regardless of the status of other accreditation and/or certifications. New PCP sites must pass their initial FSR before receiving HPSM member assignments, and an initial MRR is conducted approximately 3-6 months following the first member assignment.
Site Reviews are conducted to ensure PCP sites :
- Provide appropriate primary health care services
- Has processes in plan that support the coordination and continuity of care
- Maintains safety standards and practices
- Operates in compliance with local, state, and federal laws and regulations
There are three components of the Site Review Process:
- Facility Site Review (FSR)
- Physical assessment of PCP site including six areas: Access/Safety, Personnel, Office Management, Clinical Services, Preventative Services, Infection Control
- Medical Record Review (MRR)
- Evaluation of a member’s medical record according to six areas: Format, Documentation, Continuity/Coordination of Care; Pediatric Preventative Services, Adult Preventative Services, Obstetric Preventative Services
- Physical Accessibility Review (PAR)
- Physical accessibility evaluation of sites that provide care to members including Seniors and Persons with Disabilities (SPDs). Sites include: PCP sites, community-based adult service sites, high-volume specialist sites, other ancillary sites as appropriate. Onsite evaluation includes areas: Parking, Exterior Building, Interior Building, Restroom, Exam Room, Exam Table/Scale.
Facility Site Review Tool and Standards
A Facility Site Review is a physical assessment of procedures/practices, policies, accessibility, equipment, infection prevention protocol, medical and non-medical emergency preparedness, and some operational protocol.
Facility Site Review Resources
Access and Safety
- Office Procedure for Earthquake and Fire
- Emergency Equipment Requirements
- Emergency Medical Management
- Oxygen Tank Monthly Check
- Equipment Maintenance
Personnel
- Medical Assistant On the Job Training Certification
- Nurse Practitioner Standardized Procedure Requirements
- Bloodborne Pathogens Training and Post Test
- Bloodborne Pathogen Answer Key
- Suspect Abuse Reporting Guide
- Personnel Training Checklist
- Statement of Confidentiality
- Prior Authorization Form
- Grievance Form
- Employee Language Prescreening Tool
- Interpreter Request and Instructions
Office Management
- Patient Isolation Procedures
- Telephone Advice Guidelines
- Employee Language Prescreening Tool
- Interpreter Request and Instructions
- Grievance Form
- Potential Quality Issue (PQI) Numbers and Instructions
- Potential Quality Issue (PQI) Referral Form
Clinical Services
- Medical Storage and Distribution
- Controlled Substance Log
- Refrigerator-Freezer Log
- Medication Expiration Log
- Clinical Laboratory Improvement Amendments (CLIA) Application Process
- Lab Supplies Expiration Log
Preventive Services
Infection Control
Medical Record Review Tool and Standards
Medical Record Review Resources
Format Criteria
Documentation Criteria
Pediatric Preventive Criteria
- Blood Lead Testing
- California Management Guidelines on Childhood Lead Poisoningfor Health Care Providers
- Standard of Care Guidelines on Childhood Lead Poisoning for California Health Care Providers
- Parent/Guardian Lead Education Materials
- What Can You Do to Protect Your Child From Lead?
- Skin Cancer Counseling
- CDC Pediatric Immunization Schedule
- Tuberculosis Risk Assessment
- Bright Futures Periodicity Schedule
Adult Preventive Criteria
View more
Physicians Accessibility Review (PAR) Tool and Standards
- Physical Accessibility Review Survey- Attachment C
- Ancillary Services Physical Accessibility Review Survey- Attachment D
- Community Based Adult Services (CBAS) Physical Accessibility Review Survey-Attachment E
- MMCD Policy Letter 12-006 (PAR- Attachment C)
- APL 15-003 (CBAS and Ancillary PARS_ Attachment D and E)