The Psychiatric Services and Clinical Knowledge Enhancement System for Medicaid (PSYCKES-Medicaid) is a Health Insurance Portability and Accountability Act (HIPAA)-compliant, web-based portfolio of tools designed to support quality improvement and clinical decision-making in the New York State (NYS) Medicaid population. Providers with access to PSYCKES are able to access a portfolio of quality indicator reports at the state, region, county, agency, site, program, and client level to review performance, identify individuals who could benefit from clinical review, and inform treatment planning. Quality reports in PSYCKES are updated monthly, and clinical information is updated weekly.
Developed by the New York State Office of Mental Health (OMH), PSYCKES uses administrative data from the NYS Medicaid claims database to generate quality indicators and summarize treatment histories. This administrative data is collected when providers bill Medicaid for services. All states are required by the Federal Government to monitor the quality of their Medicaid programs, and many states are using administrative data such as Medicaid claims to support quality improvement initiatives. Quality indicators were developed in consultation with a Scientific Advisory Committee of national experts in psychopharmacology and a Stakeholder Advisory Committee of providers, family members, consumers, and professionals. Since all reports are based on Medicaid data, no data entry by providers is required.
PSYCKES uses data from state administrative databases to generate its reports. The New York State Department of Health and Office of Mental Health have a Memorandum of Understanding through which PSYCKES has access to claims data for Medicaid enrollees with a mental health service, diagnosis, or psychotropic medication. Access to Medicaid data in PSYCKES requires registration through an on-line Security Management System and an OMH-issued security token.
Under the auspices of the NYS Department of Health Drug Utilization Review Board, which is charged with overseeing the quality and safety of the NYS Medicaid program, PSYCKES releases certain protected health information (PHI) to agencies on individuals served by its programs whose medication regimens raise potential quality or safety concerns, as flagged by the PSYCKES quality indicators. This is in compliance with HIPAA and other regulations regarding PHI, which allow for release of data to support coordination of care. Agencies are not able to view PHI for clients served at their programs who do not have a quality flag without consent. In addition, certain categories of protected information, including data associated with Human Immunodeficiency Virus (HIV) status, family planning, and substance abuse, are not displayed in PSYCKES without client consent. OMH has developed a consent module that allows providers to obtain consent from consumers for access to their Medicaid data, including information with special protections.
- NYS Medicaid claims database: For consumers who receive behavioral health services or psychotropic medication paid for by Medicaid, the Medicaid claims database provides health records, such as a history of illnesses or injuries, outpatient services, hospital services, medications, dental and vision appointments, and labs or x-rays performed.
- NYS State Operated Psychiatric Center (PC) health information database: For consumers who received services from a state operated psychiatric center, this database will provide the service type, provider (name of state PC), admission date, discharge date/last date billed, and most recent primary diagnosis for the state PC visit(s).
- Department of Health (DOH) Health Home and Care Management database: For consumers enrolled in Health Homes and Care Management programs, this database provides the provider name, start date, end date, and main contact name and phone number of the Health Home and Care Management programs.
- OMH Child and Adult Integrated Reporting System (CAIRS) database: For consumers who are part of an Assertive Community Treatment (ACT) team, the CAIRS database provides the ACT provider name, start date, and main contact name and phone number.
- OMH Tracking for AOT Cases and Treatment (TACT) database: For consumers on an Assisted Outpatient Treatment (AOT) order, the TACT database provides the AOT provider name, enrollment date, and main contact name and phone number.
- New York State Incident Management and Reporting System (NIMRS) database: OMH providers utilize NIMRS to report critical incidents in real-time. For consumers who have had a suicide attempt, PSYCKES will display the incident date, name of the provider and program reporting the incident, and the severity/harm resulting from the attempt, based on information from NIMRS.
The Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) user’s guides provide instructions on how to use each section of the PSYCKES-Medicaid application:
- Login Instructions for PSYCKES-Medicaid
- Registrar Menu - PHI Access Module User’s Guide
- Recipient Search User’s Guide
- Clinical Summary User’s Guide
- My QI Report - Quality Indicator Overview User’s Guide
- Statewide Report User’s Guide
- Provider Search User’s Guide
- Brief Instructions for Using PSYCKES in Clinical Settings - Concise step-by-step instructions for using Registrar Menu and Recipient Search to access the Clinical Summary.
Comments or questions about the information on this page can be directed to the PSYCKES Team.