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The Centers for Medicare & Medicaid Services (CMS) awarded a contract to help clinicians in small practices in Maryland and the District of Columbia prepare for and participate in the new Quality Payment Program, established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

This technical assistance, authorized and funded under MACRA, brought direct support to an estimated 5500 Merit-based Incentive Payment System (MIPS) eligible clinicians in small practices with 15 or fewer clinicians, including small practices in rural locations, health professional shortage areas, and medically underserved areas across the country. The direct technical assistance was available immediately, free to all MIPS eligible clinicians, and delivered support from 2017 through 2022.

Qlarant conducted interviews with individuals receiving state or waiver funded supports and services, using a variety of interview tools and techniques to gather experiences and opinions to evaluate quality. This information was used to assess the effectiveness of service delivery systems in meeting defined needs and generating individual’s desired outcomes. One interview tool used by Qlarant in multiple states is the National Core Indicators Adult Survey (NCI) developed by Human Services Research Institute (HSRI) in collaboration with the National Association of State Directors for Developmental Disability Services (NASDDDS).

The Qlarant team is expert in utilizing the NCI tool with various populations served through the following state service programs:

  • Aging and Disabled
  • Intellectual Disabilities
  • Disabilities and Aging
  • Head and Spinal Cord Injuries

Our trained staff schedules interviews at convenient times for the individuals being interviewed. Interview environments are individualized to account for unique communication styles and needs. Findings are compiled, analyzed and reported in a timely and confidential manner. Qlarant is recognized by the Centers for Medicare and Medicaid Services as a QIO-like organization, enabling states to obtain a federal match for these quality improvement related activities.

2018-2022

Subcontractor to NORC at University of Chicago. Centers for Medicare and Medicaid Services 2014-2018

Subcontractor to Econometrica, Inc. Centers for Medicare and Medicaid Services – 2011-2014

Subcontractor to IMPAQ International, LLC. Centers for Medicare and Medicaid Services – 2011-2014

Subcontractor to IMPAQ International, LLC. Centers for Medicare and Medicaid Services – 2016-2018

Centers for Medicare and Medicaid Services – 2017-2018

Centers for Medicare and Medicaid Services – 2011-2014

Delaware Department of Health and Social Services; Division of Medicaid and Medical Assistance; Delaware Department of Insurance – 2013-2015

Virginia Department of Behavioral Health & Developmental Services (DBHDS) – 2015-2018

South Carolina Department of Disabilities and Special Needs – 2007-2012

01/25/2018 – 06/30/2018

Georgia Department of Human Resources; Division of Aging Services –

03/01/2014 – 07/31/2014

06/15/15 – 12/31/15

06/30/17 – 06/29/2018

Subcontractor to Human Services Research Institute (HSRI). Georgia Department of Human Resources; Division of Aging Services. 2014-2015

Georgia Department of Behavioral Health and Developmental Disabilities – 2008-2015

Subcontractor to Beacon Health Options, Inc. Georgia Department of Behavioral Health and Developmental Disabilities – 2015-2018

Florida Agency for Health Care Administration (AHCA) – 2010-2017

Developmental Disabilities Individual Budgeting (iBudget) Home and Community-Based Services Waiver and the Consumer Directed Care Plus (CDC+) Program – 2017-2020

California Department of Developmental Services and Department of Public Health – 2013-2015

Maryland Department of Health and Mental Hygiene – 2011-2016

District of Columbia Department of Health Care Finance – 2013-2018

Virginia Department of Medical Assistance Services – 2009-2015

For nearly a decade, Qlarant evaluated and subsequently audited potential fraud, waste and abuse of Medicaid claims dollars by beneficiaries and all types of providers in 6 of the 10 CMS Medicaid regions (34 states and D.C.). Qlarant utilized investigators, nurses, CPAs and auditors, in close collaboration with all the states and the Medicaid Fraud Control Units, to examine Medicaid health claims and/or identify issues of medical necessity or appropriateness of care when the medical records of an individual or a provider were evaluated. In addition, the MIC performed extensive medical review across all medical specialties, conducted audits of paid Medicaid claims across all provider types and settings of care to find overpayments or potential fraud and generated audit findings reports that directly resulted in recovery of money from providers. Qlarant developed a state mapping tool that contained information on eligibility and coverage for the 34 states in the MIC jurisdiction that facilitated reviews and evaluations. Qlarant’s work on the MIC contract was transitioned into its work on the UPIC contracts.

Qlarant worked with the State of Delaware from 2015 to 2020 to establish innovative and effective approaches to Medicaid fraud, waste and abuse. To that end, Qlarant utilized our in-house predictive modeling software system, PLATO, to assist the State of Delaware in evaluating its paid Medicaid claims to identify probable fraud and/or misuse of Medicaid dollars. In addition, Qlarant lent its expertise to train Delaware Medicaid employees on the use of PLATO to allow independent research of Medicaid claims and the selection of potential candidates (provider and/or beneficiary) for investigation by the State. The State of Delaware staff was also trained by Qlarant in medical review strategies.

Qlarant supported the activities of IBM Corporation by providing Predictive Modeling subject matter expertise to support the National Fraud Prevention System (“FPS”) by implementing a Predictive Modeling System capable of identifying high-risk claims and an integrated case management system that manages the predicting modeling alerts to conclusion. As a part of the IBM team, the organization provided extensive policy expertise to assist in the development of several models that have been highly successful in the FPS.