ODP s Waiver Quality Strategy Where does IM4Q fit in? Dolores Frantz, ODP Jennifer Fraker, ODP Diana Ramirez, ODP William Posavec, ODP
HCBS Quality Framework Program design sets the stage for achieving desired outcomes. Program design addresses fundamental program requirements including: service standards, provider qualifications, assessment, service planning, monitoring participant health and welfare, and critical safeguards (e.g., incident reporting and management systems). 2
Waiver Assurances " Level of Care Determinations " Service Plans " Qualified Providers " Health and Welfare " Administrative Authority " Financial Accountability 3
4 CMS Vision of CQI: DDRI Model 4 This is where data analysis comes in IMPROVEMENT Improve quality via systemic changes DESIGN Plan for and set stage for achieving positive outcomes CONTINUOUS CYCLE DISCOVERY Find positive and negative outcomes in a systematic, timely manner REMEDIATION Address negative outcomes in a timely manner
CMS Vision of CQI: DDRI Model Not a oncea-waivercycle event Continuous and Ongoing 5 The National HCBS Quality Enterprise, a Grant Funded by CMS
Improvement " Appendix H: Quality Improvement Strategy " Sums up how, where, and by whom statewide performance results will be compiled and trended over time each year for review and any systemic improvement activities needed " Brings together data for analysis from a variety of sources that support the QIS, including IM4Q/ NCI data, HCSIS, PROMISe, AE, Provider, and SCO Monitoring data, and data from ad hoc databases 6
7 CMS Expectations for QIS Performance measures required for all assurances and sub-assurances Should be continually reaching 100% compliance Should be able to aggregate remediation and show how quickly issues are resolved Should be able to describe and document methods of remediation Should be able to describe relevant quality improvement initiatives (training, policy change, etc.) Can use consumer surveys in conjunction with all other data
Remediation <100% Discovery Evidence 100% Remediation Evidence 100% Compliance 8 The National HCBS Quality Enterprise, a Grant Funded by CMS
Service Plans Assurances The State demonstrates it has designed and implemented an effective system for reviewing the adequacy of service plans for waiver participants. " Sub-Assurance A: Service Plans address all participants assessed needs (including health and welfare risk factors) and personal goals, either by the provision of waiver services or through other means. " Sub-Assurance B: The State monitors service plan development in accordance with its policies and procedures. 9
" Sub-Assurance C: Service plans are updated/ revised at least annually or when warranted by changes in the waiver participant s needs. " Sub-Assurance D: Services are delivered in accordance with the service plan, including the type, scope, amount, duration and frequency specified in the service plan. " Sub-Assurance E: Participants are afforded choice between waiver services and institutional care, and between/among waiver services and providers. 10
11 Service Plans Subassurance A Consolidated Waiver Data Source: AEOMP Cycle 1 (CY 07-08) Cycle 2 (CY 09-10) Cycle 3 YTD (FY 11-12) n % Compliant n % Compliant n % Compliant Q2.A. All assessed needs are addressed in the ISP. Q4.A. The outcomes listed on the ISP relate to an identified preference. 435 93% 221 95% 1254 91% 435 97% 221 98%
Service Plans Subassurance A Consolidated Waiver Health and Welfare risk factors are assessed; Risk factors are mitigated where appropriate Data Source: AEOMP Q1.0H. Risk assessment is completed. Q1.0I.01. If yes, services and supports to mitigate identified are incorporated into the ISP. Cycle 1 (CY 07-08) n % Compliant Cycle 2 (CY 09-10) Cycle 3 YTD (FY 11-12) n % Compliant n % Compliant 221 99% 199 95% 12
Service Plans Subassurance B Consolidated Waiver Service Plan Development is Monitored Data Source: AEOMP Cycle 2 (CY 09-10) Cycle 3 YTD (FY 11-12) Cycle 2: Q7.B. Do you attend your ISP meeting? Cycle 3: Q6.A. There is documentation that the waiver participant attended the ISP meeting. Cycle 2: Q7.A. There is documentation that the required members of the team were invited to the ISP meeting. Cycle 3: Q6.B. There is documentation that the required members of the team attended the ISP meeting. 13 n % Compliant 266 99.6% 435 87% n % Compliant 221 96% 221 94%
14 Service Plans Subassurance B Consolidated Waiver Service Plan Development is Monitored Data Source: AEOMP Cycle 2 (CY 09-10) Cycle 3 YTD (FY 11-12) Cycle 2: Q3.B. Service frequency is indicated in the ISP. Cycle 3: Q3.A. Service frequency is indicated in the ISP. Cycle 2: Q1.C. Were all services and supports in the approved ISP? Cycle 3: Q1.C. Were all services and supports in the approved ISP? n % Compliant 435 83% 435 95% n % Compliant 221 93% 221 98%
15 Service Plans Subassurance B Consolidated Waiver Service Plan Development is Monitored Data Source: AEOMP Cycle 2: Q8.B.1. The AE authorizes services consistent with the service definitions. Cycle 3: Q7.0A. The AE authorizes services consistent with the service definitions. Cycle 2: Q8.B.2. The AE authorized qualified providers to deliver all services authorized in the ISP. Cycle 3: Q7.0C. The AE authorized qualified providers to deliver all services authorized in the ISP. Cycle 2 (CY 09-10) n % Compliant 393 94% 435 97% Cycle 3 YTD (FY 11-12) n % Compliant 221 97% 221 100%
16 Service Plans Subassurance E Consolidated Waiver Choice of Services is offered Data Source: AEOMP Cycle 1 (CY 07-08) n % Compliant Cycle 2 (CY 09-10) Cycle 3 YTD (FY 11-12) n % Compliant n % Compliant Q50.A Documentation indicates choice between and among services was offered to the individual/family. Q24.0A. There is documentation that indicates choice between and among services was offered to the individual/family. 422 59% 318 47% 221 95%
17 Service Plans Subassurance E Consolidated Waiver Choice of Providers is offered Data Source: AEOMP Q51.A Documentation indicates choice of willing and qualified service providers was offered to the individual/family. Q25.0A. There is documentation that indicates choice of willing and qualified service providers was offered to the individual/family. Cycle 1 (CY 07-08) n % Compliant Cycle 2 (CY 09-10) n % Compliant 726 56% 421 67% Cycle 3 YTD (FY 11-12) n % Compliant 221 95%
18 Service Plans Subassurance D Consolidated Waiver Services and Supports are delivered Data Source: AEOMP Cycle 2 (CY 09-10) Cycle 3 YTD (FY 11-12) Cycle 2: Q1.C.2. Based on AEO Review of records, all services and supports in the approved ISP were received. Cycle 3: Q1.0D.01. Based on HCSIS monitoring reports, all services and supports in the approved ISP were received. n % Compliant 435 87% n % Compliant 221 95%
19 Individuals receive services they need Services Delivered in Accordance with the Plan Percent of waiver participants who indicated they received the services they need FY 06-07 FY 07-08 n % Compliant n % Compliant Consolidated Waiver 888 78% 1107 79% Data Source: IM4Q
Individuals receive services they need 20
Individuals receive services they need 21
Individuals receive services they need 22
Individuals receive services they need 23
24 Health and Welfare " The State demonstrates, on an ongoing basis that it identifies, addresses and seeks to prevent instances of abuse, neglect and exploitation.
25 Health and Welfare Consolidated Waiver Data Source: HCSIS Data Extraction Date: 06/20/12 (100% Review) FY 06-07 FY 07-08 FY 08-09 FY 09-10 FY 10-11 Number of Confirmed Incidents of Abuse, Neglect, and Exploitation Abuse 423 447 481 549 588 Individual to Individual Abuse Other investigated injuries determined to be abuse 40 29 31 33 44 65 60 63 83 78
Health and Welfare Consolidated Waiver Data Source: HCSIS Data Extraction Date: 06/20/12 (100% Review) FY 06-07 FY 07-08 FY 08-09 FY 09-10 FY 10-11 Number of Confirmed Incidents of Abuse, Neglect, and Exploitation Neglect 646 653 770 887 974 Rights Violation Misuse of funds 105 74 131 179 128 324 260 262 313 313 26
Health and Welfare Critical Incident Review " # and % of critical incidents in which prompt action (demonstrated within 24 hours) is taken to protect the participant s health, safety and rights " # and % of AEs that review incidents within 24 hours of the report " # and % of critical incidents finalized within the required timeframe (30 days) 27
28 Health and Welfare Investigation of Critical Incidents " # and % of AEs that completed investigations in accordance with ODP standards " # and % of confirmed critical incidents where corrective actions were carried out or planned by the appropriate entity within the required timeframe " # and % of AEs that maintain documentation of incident management training
Health and Welfare Consolidated Waiver Data Source: HCSIS Data Extraction Date: 06/20/12 (100% Review) FY 06-07 FY 07-08 FY 07-08 FY 07-08 FY 08-09 Number of Incidents of Restraints 2,864 2,879 2,536 3,259 3,053 Unduplicated Count of Individuals with Restraints 369 355 344 342 330 Number of Medication Errors 7,984 8,388 8,172 8,405 8,458 29
30 Health and Welfare Training in Reporting Abuse " # and % of waiver participants who received information about reporting abuse, neglect, and exploitation.
Individuals Feel Safe Consolidated Waiver Data Source: IM4Q FY 06-07 FY 07-08 Percent of individuals who feel safe in their homes Percent of individuals who feel safe during day activity Percent of individuals who feel safe in their neighborhood n % n % 1541 81% 1930 80% 1388 87% 1662 90% 1545 84% 2254 72% 31
Individuals Feel Safe at Day Activity 32
Individuals Feel Safe at Day Activity 33
Individuals Feel Safe at Day Activity 34
Individuals Feel Safe at Day Activity 35
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