Each of SUD Specialty Group -- CA; Mental Health Specialty Group, P.A.; Mental Health Specialty Group NJ, PC; and Mental Health Specialty Group KS, P.A. (collectively, the "Group") contracts with Path CCM, Inc. d/b/a Rula Health (the “Network”) for management and administrative support services. The Network Quality Standards apply to all providers contracted by Group entities who use the Network. All of the foregoing entities are collectively referred to as “Rula” herein.
Rula takes a systematic approach to quality. We are constantly improving our tools, processes, and programs to support the following core tenets of quality:
- Measurement Informed Care (MIC) is Rula’s standard of care. MIC helps patients get better, faster; makes provider documentation easier; and can help mitigate provider risks.
- Patient safety strategies and safety planning are paramount to good care.
- Appropriate, timely responsiveness to patients is critical for good care.
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Appropriate, timely, and accurate documentation is necessary not only for reimbursement and good care but also to help mitigate provider risks.
We ask all of our providers to embrace and acknowledge these principles and adhere to the following specific expectations:
- Professionalism and Ethical Conduct: Providers will maintain the highest levels of professionalism, accountability, and ethical behavior in all aspects of their practice. This includes, but is not limited to, maintaining a professional appearance; conducting sessions in confidential, HIPAA-compliant settings; and following all ethical and legal guidelines relevant to their profession and licensure. Access to Rula’s systems and patient PHI is restricted to contracted providers only. Access may not be shared with or delegated to any third parties, including office staff, interns, or supervisees. Providers will apply evidence-based practices and avoid harmful practices.
- Clinical Quality and Compliance: Providers will engage with Rula staff in ongoing quality improvement initiatives, including engaging and responding to Rula’s Grievance Coordinator and Quality Specialists, and Compliance team members within three (3) business days. Providers are also expected to participate in Utilization Management (UM) reviews from Rula's partner insurance payers. Providers will participate in periodic reviews of patient care practices, including chart audits and peer reviews, assessments of provider responsiveness, and patient experience to ensure adherence to best practices and compliance with professional, state, and federal laws and guidelines. Additionally, providers must be physically located in the United States to provide services due to regulatory, payer, and privacy requirements.
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Measurement-informed care (MIC): All Rula Providers will utilize measurement-informed care as a best practice and standard of quality care at Rula. Utilization includes 2 components:
- Patient Completion: Rula will administer measures to patients as a part of their care at Rula. Providers are expected to support completion by encouraging participation, addressing barriers, and offering administration of measures live during session, among other strategies.
- Provider MIC Review Rate: Any completed measures must be reviewed by the provider in a timely manner. The provider will consistently incorporate completed patient MIC surveys into care by reviewing them with patients and using results to inform treatment planning and interventions.
- Documentation: Providers will maintain timely and accurate documentation that adheres to legal and regulatory requirements. Timely documentation is defined as documentation that is signed and submitted within 48 hours after the conclusion of the clinical visit. Accurate documentation is defined as documentation that reflects the correct service date and time, details regarding the visit, and accurately depicts medical necessity for each individual client. Timely and accurate documentation is a material part of the services providers agree to render under the Network Access Agreement.
- Communication and Patient Messaging: Providers will ensure all interactions and communications are conducted respectfully and collaboratively. Providers will respond promptly to patient messages, ideally within one business day and, if applicable, to medication refill requests within 24 hours to ensure continuity of care and patient satisfaction.
- Patient Engagement and Experience: Providers will engage patients after their initial appointment for continued follow-up visits and/or referral as appropriate to ensure clinically appropriate follow-up care. Providers will maintain a strong therapeutic alliance and promote a positive relationship with their patients.
- Safety and Adverse Events Reporting: Providers will follow their state licensure, state laws, and applicable regulations regarding clinical risk; perform ongoing risk assessments; develop safety plans with patients as clinically indicated; and document the same in the patient’s clinical record. Providers will report instances of adverse or potentially adverse events to Rula’s Quality Team within 24 hours of the provider’s discovery, awareness, or notification of the event.
- Schedule and Caseload Management: Providers will keep their schedule updated and show up to all scheduled appointments. Therapists will maintain a caseload of no more than 70 patients at any given time (not the maximum number of hours worked) to maintain quality standards and reduce the risk of burnout. Rula also enforces a daily visit maximum: therapy providers should not hold more than 11 visits per day, and psychiatric providers should not hold more than 22 visits per day.
- Lab Orders (if applicable): Providers will order labs or obtain lab records that are clinically appropriate and adhere to professional standards, taking into account changes in patient status and medication-related blood monitoring guidelines.
- Medication Management (if applicable): Providers will prescribe medications according to established professional guidelines. This includes prudent use of controlled substances and adherence to both state and federal regulations.
In-person care (if applicable): Providers will adhere to the highest levels of quality and professionalism as outlined in the In-Person Session Checklist.
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