Cultural Competence Standards in Managed Mental Health Care

Governance

Standard
Each health plans' governing entity shall incorporate a board, advisory committee, or policy-making and -influencing group which shall be proportionally representative of the consumer populations to be served and the community at large, including age and ethnicity. In this manner, the community served will guide policy formulation and decision making, including Request for Proposals development and vendor selection. The governing entity responsible for the Health Plan shall be accountable for its successful implementation, including its cultural competence provisions.

 

Implementation Guidelines

  1. The Health Plan shall include formal procedures for decision-making related to policies, practices, and grievances in accordance with state and federal law with racial/ethnic community and professional input, participation, and involvement at all levels, including fair hearings. Consumers shall be informed of this procedure in their own language at intake and supported linguistically at the time of any steps in the complaint and grievance process.
  2. The Health Plan shall make available a culturally competent group of ombudspersons (minimally comprised of consumer, family member, and regional representatives) to be involved in all appeals and concerns from the community served. The group of ombudspersons shall have independence from the Health Plan, and there shall be formalized procedures for resolving differences of opinion between the ombudsperson and the Health Plan administration’s governance.
  3. The governing entity shall determine for each Health Plan an equitable percentage of profit or savings to be reinvested in racial/ethnic community-based services and preventive programs on an ongoing basis. A financial penalty or termination of contracts is applicable when inequities exist to access and/or comparability of benefits.
  4. The Health Plan shall develop interagency and cross-system agreements or pooled funding to coordinate services with other agencies (e.g., public health, social services, corrections and juvenile justice, youth services, education, substance abuse, developmentally disabled services).
  5. Financial and liability risks for the Health Plan shall be distributed such that culturally competent smaller scale providers and organizations will be able to continue to deliver services.
  6. Policies governing practitioner ethics and behavior (e.g., gift giving by consumers, interactions with consumers outside the service setting, confidentiality) shall provide for differences relevant to the context of racial/ethnic cultural values.
  7. Contract continuation and renewal shall be contingent upon successful achievement of performance standards which demonstrate effective service, equitable access and comparability of benefits for populations of the four racial/ethnic groups.

Recommended Performance Indicators

  1. Racial/ethnic consumer awareness of and participation in Health Plan benefits, appeals procedures, and ombudspersons, as demonstrated by the comparability of the rate of grievances and complaints.
  2. The percentage of complaints and grievances of individual practitioners is tracked and factored into performance evaluations.
  3. Presence of culturally-informed policies of practitioner behavior and performance-based demonstrations of implementation.

Recommended Outcomes

  1. Final disposition of grievances and appeals for consumers from the four groups.
    Benchmark: Comparable to overall service population.
  2. Percent of consumers from the four groups receiving blended, coordinated, or wrap-around services.
    Benchmark: Comparable to overall service population and increasing over time.
  3. Percentage of reports of unethical practitioner behavior for practitioners serving populations of the four groups.
    Benchmark: Comparable to overall service population.
  4. Sanctions and incentives reinforce progress toward the delivery of culturally competent services.
    Benchmark: Decreased rates of sanction over time.
  5. Composition of the governing board, advisory committee, other policy-making and influencing groups, and consumers served reflects service area demographics.
    Benchmark: 90% of expected representation.
  6. Consumer awareness of plan.
    Benchmark: 80% of surveyed respondents aware of plan.
  7. Culturally-based policies shaping practitioner behaviors and measuring performance.
    Benchmark: Presence of policies.