PCA Provider Quality Today

Transcription

1 PCA Provider Quality Today Home Care Association 42 nd Annual Meeting May 16, 2010 Presented by Audrey Fischer MN Department of Human Services Disability Services Division 1 Objectives 1. To gain knowledge regarding PCA provider agencies in Minnesota 2. To learn what is going well regarding PCA service delivery 3. To understand where improvements may be needed 4. To identify best practices for PCA agencies 5. To develop an increased understanding of PCA and PCA-QA s role 2 PCA Services Optional Medicaid Service 1977 became part of MN Home Care Services Lead agencies assess Recipients have choice of provider agency Provider agencies provide the service Qualified Professional and PCA deliver service DHS reimburses the agencies 3 1

2 PCA Provider Agencies Medicaid (MA)-enrolled with MHCP PCA provider organizations PCA choice agencies Class A license nursing agencies Medicare-certified home health agencies Must meet certain requirements 4 PCA Provider Agency requirements Complete and keep required documentation Provide training for PCAs Establish and implement agency policies and procedures Comply with other general duties established in statute 5 PCA Provider Agencies History Training for Provider Agencies Lewin Report Office of Legislative Auditor s Report 2009 Legislation PCA Redesign PCA Quality Assurance 6 2

3 PCA Quality Assurance Lewin Report Office of Legislator Auditor s Report Legislative directive To monitor program integrity Provider standards and training Consumer surveys Random reviews of documentation 7 PCA Quality Assurance Legislative authority to request proof of documentation in meeting: Provider standards Quality standards of care Correct billing practices Other information 8 PCA Quality Assurance Carrying out the legislative directives- need a system that works on-going Revisions made to this area PCA Portal page Development of a database Establish a system that will work over time 9 3

4 PCA Quality Assurance PCA Portal - PCA-QA Page Posted 4/25/11 Quality assurance: Guarantee program integrity through review of the services that are reimbursed by Medicaid/Medical Assistance, a combination of state and federal government funds 10 PCA Quality Assurance DHS has the authority and responsibility to: Safeguard the health and welfare of Medicaid recipients Oversee and monitor the program Be accountable for the Medicaid spend Numerous methods utilized On-going process 11 PCA-QA Responsibilities DHS Lead Agencies MCO PCA Provider Agencies-provide access to all agency records and documentation Employment files of all staff Client files and all required service information Policy and procedure manuals Accounting, payroll and billing records Documentation of all training requirements 12 4

5 PCA Quality Assurance Developed an Internal database system Information combined from MMIS Access to current agencies and recipients Access to history of agencies and recipients Generate reports Flagging for further information 13 PCA Quality Assurance Information from agency reviews Desk Reviews Site Reviews Discovery Lack of numbers of reviews Need for additional information What is the Quality of PCA Services? 14 PCA Quality Assurance Need to determine: What is working well Where are improvements needed Need Information from additional provider agencies Established Questionnaire Stakeholders Meeting 15 5

6 PCA Quality Assurance Request Data with Agencies Self-Reporting Service Delivery Policies, procedures and business practices Enrolling, affiliation and contracting Recruitments, wages and benefits Program integrity Utilization of the SNAP survey 16 PCA Quality Assurance Communication & Implementation Stakeholder meeting Advocacy agencies MHCP Provider News MHCP Provider Update MNTS mailbox Phone calls 17 PCA Quality Assurance Data Collection Time Period January 1 June 30, 2010 Identified 563 agencies Data Collection Results Self-Report Data 533 Responses Final Response 469 agencies 18 6

7 Data Collection Demographics Using 449 responses Ranged in size from 1 to over PCA Recipients served by agencies 20 Data Collection Areas Addressed Service delivery Policies, procedures and business practices Enrolling, affiliation and contracting Recruitment wages and benefits Program integrity Additional Open-ended questions 21 7

8 Service Delivery Assists in identifying the following: Increased understanding of the recipients being served Frequency of recipients use of the PCA Choices & options Identify agencies similarities and differences Increased understanding of agencies knowledge of laws and policies of the program Identify documentation standards 22 Service Delivery Agencies identified recipient use of special services or options with PCA Program Responsible party Shared services PCA Choice: Lived with PCA Having more than 1 agency Restricted to standard use 23 Service Delivery Agencies identified serving recipients of multiple languages Agencies English Hmong Somali Spanish Russian Vietnamese # reporting % of total 98% 26% 26% 21% 11% 16% 24 8

9 Service Delivery Agencies identified recipient use of special services or options with PCA Program Responsible party Shared services PCA Choice: Lived with PCA Having more than 1 agency Restricted to standard use 25 Service Delivery Written agreements with recipients Provider Owned or controlled housing Services provided prior to receiving service authorization Recipients None 1-25% 26-50% 51-75% 76-99% 100% number percent 77% 16% 03% 01% 03% 0 26 Service Delivery Receiving Service Plans 278 (62%) non-waiver 223 (50%) waiver Participation in Developing Care Plans Overuse of hours Recipients None 1-25% 26-50% 51-75% 76-99% 100% Provider agencies #reporting % of total 50% 44% 03% 0% 03% 0% 27 9

10 Service Delivery Home Care Bill of Rights 99% Individual Abuse Prevention Plan 88% 3 or less individual PCAs per Recipient 59% # PCAs per recipient Agency # Provider % 3 or fewer % % % % 10 or more 37 08% 28 Service Delivery Qualified Professional (QP) Credentials Qualified Professional s Credentials Number of Agencies Percent of Agencies Nurse (Registered N) % Licensed Social Worker (LSW) 78 17% Developmental Disability Specialist (QDDS) 38 08% Mental Health Professional 10 2% 29 Service Delivery Documentation Required by the QP Signature & title of QP 94% Date on which service provided 92% Date of entry 89% Services provided according to Care Plan 86% Changes in Recipient s condition 85% Recipients health condition and/or changes 85% 30 10

11 Service Delivery Documentation Required by QP (continued) Response of recipient to services 83% Length of time spent with recipient 79% Recipient s comments 76% Date/length of time training/evaluating PCA 74% Review of planned use of hours 68% 31 Service Delivery Summary 32 Policies, Procedures and Practices 99% of Agencies responded they have the following required policies & procedures: Employee hiring & termination Employee misconduct Internal controls & process for service delivery Safety practices Recipient grievance Training requirements 33 11

12 Policies, Procedures and Practices Agency Policies and Procedure Manuals Identifies the date written 87% Identifies the date reviewed 80% Updated between Jan-June % Includes Emergency preparedness and Contingency Plan 78% 34 Policies, Procedures and Practices Agency s Additional Training Requirements Additional Role of Agency Staff Time Biller Managers Owners PCAs QPs 0 hours % % % 51 11% 92 20% 1 2 hours 89 19% 67 14% 51 11% % 56 12% 3 4 hours 85 18% 66 14% 52 11% 93 20% 74 16% 5 6 hours 33 07% 34 07% 34 07% 50 11% 36 08% 7+ hours % % % % % 35 Policies, Procedures and Practices Accompanying Recipients into the community Provide a vehicle for the PCAs 11% Permit PCAs to drive own vehicle 44% Permit PCAs to drive recipient's vehicle 38% Recipients use another vehicle & driver 51% 36 12

13 Policies, Procedures and Practices Marketing and Advertising Copies of all printed information that goes out 68% Maintain distribution list 29% Information on costs 48% Identify specific products purchased 40% Information as to when & where distributed 35% 37 Policies, Procedures and Practices Verifying a PCA is working as scheduled Method Agencies Announced home visits % Unannounced home visits % Scheduled telephone calls % Unscheduled phone calls % 38 Policies, Procedures and Practices Notifying MHCP when PCA no longer affiliated 39 13

14 Policies, Procedures and Practices 94% of the agencies do have a procedure to ensure requests for PCA reassessments are made 60 days prior to the end of each recipient s current service authorizations 40 Policies, Procedures and Practices Summary 41 Enrolling, Affiliation and Contracting Provides information regarding: Agencies enrollment and other licenses Contracting with managed care Background studies process Hiring individual PCAs Wages and benefits for PCAs Billing for services 42 14

15 Enrolling, Affiliation & Contracting Enrollment with MHCP Type Responses PCPO/ Traditional % PCA Choice % Home Health Agency % 43 Enrolling, Affiliation & Contracting 44 Enrolling, Affiliation & Contracting Contracted with Managed Care Organizations Managed Care Organization Agencies Contracted # % Blue Plus % Health Partners 82 18% Itasca Medical Care 15 03% Medica % Metropolitan Health Plan 61 13% Prime West 46 10% South Country 82 18% UCare % 45 15

16 Enrolling, Affiliation & Contracting Agency response regarding background studies On the average, 405 (86%) completed within 10 days 40% of agencies had no studies taking over 10 days When in pend status, average days to get results 30 or fewer 48% % % Over 90 07% N/A 15% 46 Enrolling, Affiliation & Contracting Average amount of time to affiliate a PCA Number of Days Agency Response # % % % % % % N/A 27 06% 47 Enrolling, Affiliation & Contracting Summary 48 16

17 Recruitment, Wages & Benefits Individual PCAs Timecards Wages Under 18 Benefits Qualified Professionals 49 Recruitment, Wages & Benefits Formats Utilized for Time Cards Identified Format Used for time cards Agencies responded Yes Call in 29 06% Electronic 27 06% Paper, agency format % Paper, DHS format % Phone 24 05% Web based 06 01% Other 09 02% 50 Recruitment, Wages & Benefits Unbillable Qualified Professional Tasks Non-billable qualified professional Tasks Agencies, Yes, were aware Administrative tasks completed in the office % Attending training % training agency staff other than PCA training in the recipients % Home Coordination and scheduling of PCAs % Direct professional nursing tasks % Tasks delegated to non qualified qualified professionals % Traveling to or from the recipient s home % Unscheduled visits with the recipient that were not identified in the % care plan 51 17

18 Recruitment, Wages & Benefits Agencies that had PCAs under (25%) Only 1-2 Agencies reported the following PCA Wages Starting wage varied from $ $ Highest wage ranged from $ $ Lowest wage ranged from $7.25-$ Recruitment, Wages & Benefits Benefits for the Individual PCAs Individual PCA Benefits Agencies # % None/N/A % Attending training % Insurance benefits* 95 20% Paid vacation % Retirement 53 11% Sick leave 60 13% Transportation between recipients 48 10% Tuition/ education 48 10% Wellness program 20 04% Other % 53 Recruitment, Wages & Benefits PCAs Working over 40 Hours per Week % PCAs working 40+ hours Agency Providers # % 0% (None) 95 21% 1 25% % 26 50% 68 15% 51 75% 16 04% 76 99% 0 0% 100% 4 01% 54 18

19 Recruitment, Wages & Benefits Summary 55 Program Integrity This area provides data regarding: Use of agency program evaluation Other agencies reviewing records Employee maltreatment investigations 56 Program Integrity Program Evaluations Used by 367 (78%) of the PCA provider agencies Evaluations may be regarding recipient and/or employee satisfaction Time Period Agency Response Recipient satisfaction Employee satisfaction Jan-June % % % 46 10% % 13 03% 2007 or before 32 07% 44 09% None to date % % 57 19

20 Program Integrity Agency s Recipient Records Reviewed between January 1 June 30, 2010 Entity reviewing Recipient Records Agency # County/tribe holding a contract for extended PCA 43 09% Managed Care Organization (MCO) % MN Department of Human Services (DHS) % MN Department of Health (MDH) 76 16% 58 Program Integrity Employee Maltreatment investigations None reported 379 (81%) 1-25% range 89 (19%) 59 Program Integrity Summary 60 20

21 Open-Ended Questions 1. Most challenging business or program area the agency encountered this past year. 2. Describe the most successful business or program practice the agency was directly responsible for this last year 61 Summary Discoveries PCA agencies overall are doing well in the following areas Some improvements are needed in the following What s next? 62 References Minnesota Statute 256B.0651 subd. 15 & 16 Minnesota Statute 256B.0652 Lewin Group, July Office of Legislative Auditor Report on PCA, Jan PCA Portal 63 21

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