CMS QUALITY FRAMEWORK: EXPECTATIONS FOR QUALITY IN HCBS WAIVER PROGRAMS - PowerPoint PPT Presentation

Loading...

PPT – CMS QUALITY FRAMEWORK: EXPECTATIONS FOR QUALITY IN HCBS WAIVER PROGRAMS PowerPoint presentation | free to view - id: 9f448-MTgwO



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

CMS QUALITY FRAMEWORK: EXPECTATIONS FOR QUALITY IN HCBS WAIVER PROGRAMS

Description:

2004, CMS issues new guidance to Regional Offices on conducting a review of a ... Develop quality indicators for individuals who live in their own or family homes ... – PowerPoint PPT presentation

Number of Views:145
Avg rating:3.0/5.0
Slides: 35
Provided by: ADM7152
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: CMS QUALITY FRAMEWORK: EXPECTATIONS FOR QUALITY IN HCBS WAIVER PROGRAMS


1
CMS QUALITY FRAMEWORKEXPECTATIONS FOR QUALITY
IN HCBS WAIVER PROGRAMS
  • Laura Nuss, CT DMR
  • September 29, 2004
  • Annual CCPA Conference

2
CMS-National Picture
  • Increase Quality Assurance and Improvement
    oversight of state Home and Community Based
    (HCBS) waivers
  • CMS issues HCBS Waiver Protocols in 2001
    detailing quality assurance and improvement
    expectations for the states.
  • In August 2002, CMS distributes the Quality
    Framework to provide a common frame of reference
    focusing attention on desired outcomes of quality
    management.
  • July 2003, General Accounting Office (GAO)
    criticizes CMS for failure to aggressively
    monitor state oversight of HCBS waivers.
    Recommends CMS strengthen monitoring with more
    stringent requirements for states to report QA/QI
    activities.
  • 2004, CMS issues new guidance to Regional Offices
    on conducting a review of a states HCBS waiver.
  • 2004, officially adopts Quality Framework.
  • 2004, develops new waiver application that
    includes Quality Framework expectations

3
CMS-National Picture - continued
  • New Freedom Initiative
  • Makes it a priority of the federal government to
    promote community living for persons with
    disabilities of all ages
  • Focus on the rights of all individuals with
    disabilities to learn and develop skills, engage
    in productive work, choose where they live and
    participate in community life
  • Provides Real Choice Systems Change Grants aimed
    at building infrastructure that will result in
    effective andenduring improvements in community
    long-termsupport systems
  • Initiates the Independence Plus waiver to
    offerimmediate opportunity to improve quality
    throughincreased choice and control on the part
    of peoplewith a disability or elderly.

4
HCBS Waivers-What are they and why do we care?
  • Optional Medicaid program that allows states to
    request a waiver from federal Medicaid
    regulations to provide community-based services
    and supports as an alternative to Medicaid State
    Plan services such as nursing homes and
    Intermediate Care Facilities (ICF)
  • Provides Federal Financial Participation (FFP) by
    matching state funds expended for waiver services
    (50 77)
  • Connecticut DMR has had a waiver since 1987, with
    an FFP rate of 50
  • In 2002, 42 of all spending for MR services in
    CT was through the waiver (US Average 37, range
    10-80) State of the States in Developmental
    Disabilities, 2004, Braddock et. al.
  • In 2003, DMR services returned 300 million in
    federal revenue
  • Revenue helps the department work with the state
    to increase funds for those waiting for services
    and supports

5
CT DMR HCBS Waivers
  • Proposed second waiver requested for January 2005
    implementation
  • Targeted towards increasing availability and
    variety of services and supports for people who
    live in their own or family home
  • Shifts service delivery model to consumer choice
    and control even further
  • Must include methods to address the Quality
    Framework
  • Current waiver supports 6,000 plus individuals
  • Expires October 2005
  • CMS conducts a quality assurance review prior to
    allowing it to be renewed
  • CTs review initiated June 2004
  • Authorized services residential habilitation
    (CLA and CTH) day habilitation (DSO, SE)
    respite environmental modifications family
    training

6
Quality Framework Expectations
  • Design Designing quality assurance and
    improvement strategies into the HCBS program at
    the initiation of the program
  • Discovery Engaging in a process of discovery
    tocollect data and direct participant
    experiences inorder to assess the ongoing
    implementation of theprogram, identifying both
    concerns as well as otheropportunities for
    improvement
  • Remedy Taking actions to remedy specific
    problems or concerns that arise
  • Continuous Improvement Utilizing data and
    quality information to engage in actions that
    assure continuous improvement in the HCBS
    program.

7
Quality Framework uniform nationwide format
that makes states describe the key components of
the states QA/QI program in a consistent and
standard manner.
DOMAIN AREAS
  • Participant access
  • Participant-centered service planning and
    delivery
  • Provider capacity and capabilities
  • Participant safeguards
  • Participant rights and responsibilities
  • Participant outcomes and satisfaction
  • System performance

8
QUALITY FRAMEWORK AND DMR INITIATIVES
  • Participant Access
  • Information and Referral
  • -Waiver info available
  • Intake and Eligibility
  • -user friendly
  • -linked to community resources
  • -choice between waiver and ICF/MR
  • -services initiated promptly
  • Waiver Fact Sheets
  • Lower CM case loads
  • Quarterly audits of records by CO Waiver Unit

9
QUALITY FRAMEWORK DMR INITIATIVES
  • Person-centered Planning
  • Comprehensive assessment preferences, goals,
    health, needs, and other supports
  • Participant decision-making-help to make informed
    choices
  • Free choice of providers-info and support
  • Comprehensive service plan-for all services to
    address all needs
  • Self-direction- have authority and support to do
    so
  • Revised Person-centered Plan
  • Lower CM Caseloads
  • Emphasis on CM representing all aspects of
    individuals life
  • Portability
  • Individual Budgeting
  • New waiver service for broker supports
  • Improve Self-advocacy training and support
  • Standard review of quality of the plan by CM
    supervisors
  • Quarterly audits of plan and choice by CO Waiver
    Unit

10
QUALITY FRAMEWORK DMR INITIATIVES
  • Service Delivery
  • On-going service and support coordination- have
    continuous access to assistance to obtain and
    coordinate services and promptly address issues
  • Service Provision- are furnished according to the
    IP
  • Ongoing monitoring- regular, systemic and
    objective methods, including the persons
    feedback, use to monitor health, well being and
    achievement of personal goals
  • Responsiveness to changing needs- changes
    promptly trigger consideration of modifications
    in the IP
  • Lower CM case loads
  • Design methods for CMs to consistently review IP
    and collect data permitting systemic analysis
  • Implement consistent supervisory documentation to
    demonstrate effectiveness of oversight
  • Quarterly audits by CO waiver unit
  • Regional and State Quality Review visits include
    consumer interview

11
Planning Cycle
  • Develop Plan
  • CM attends plan development meeting
  • Ensures individual participates
  • Ensures plan meets requirements
  • Ensures documentation on form.
  • Prepare to Develop Plan
  • Asks preferences for planning
  • Reviews record/current plan
  • Ensures Health/Safety Screening complete
  • Checks current assessments are available and
    complete
  • Ensures team notified of meeting.
  • Access to Supports
  • Makes referrals
  • Offers choice/selection
  • Portability process
  • Resource development.
  • Monitor Supports and Review Plan
  • CM visits in-home and day site
  • Ensures plan implemented
  • Ensures supports are in place and working
  • Checks Health and Safety Screening
    recommendations and follow-up assessments are
    implemented
  • Conducts probes
  • Review plan and revise as needed.
  • Initial Intake and Interview
  • CM Assessment/Profile
  • Gather background information
  • Share information
  • Share fact sheets
  • Gather CAMRIS information
  • H/S Screening
  • Prepare for Individual Plan.

12
Self-Directed Support
  • The use of individual support agreements provides
    consumers and their families with greater choice
    and control over the services and supports they
    need and desire. The expansion of such
    self-directed support has, therefore, represented
    a major goal for DMR over the past five years.

As of the beginning of January 2004, over 800
individuals now have individual support
agreements, with almost 600 consumers and their
families exercising this choice for residential
support.
13
CMS Grants to States
  • Independence Plus for projects earmarked to
    build the necessary infrastructure required to
    submit an Independence Plus waiver
  • Person-centered planning and service delivery
  • Support Coordination/Brokerage
  • Fiscal Intermediary Services
  • Individual Budgeting Methodology.

14
The Future of Individual Budgeting in Connecticut
  • CMS Independence Grant
  • Public process of establishing Level of Need and
    associated funding
  • Use of key informant interviews analysis of
    individual characteristics, which drive support
    needs analysis of current funding levels
    associated with individual characteristics and
    PCP planning process samples to arrive at an
    individual budget methodology
  • Use the methodology to support the application of
    an Independence HCBS Waiver and to revise the
    current comprehensive waiver
  • Identify current individual funding amounts for
    all individuals currently supported so anyone can
    choose to self-direct existing resources
  • Apply methodology to new individuals entering
    service for FY05
  • Apply methodology to service system at large to
    plan a long-term equitable resource allocation
    process.

15
Accessing Individual Supports
  • Individuals can choose to convert existing
    funding within provider agency contracts and make
    it portable
  • Individuals who are on the day and/or residential
    waiting list when entering service, may choose an
    individual support option
  • To date in FY04, 86 people chose to exercise the
    option of portability
  • Effective April 1, 2004, all people,regardless
    of setting, have portableresources.

16
QUALITY FRAMEWORK DMR INITIATIVES
  • Provider Capacity and Capabilities
  • Networks and availability- enough providers to
    meet needs and provide choice
  • Provider Qualifications- agency and individual
    providers possess required skills, etc.
  • Provider Performance- all providers demonstrate
    ability to provide services in an effective and
    efficient manner per the plan
  • Formal Provider Enrollment Initiative to create
    directories and expand options
  • Expand training opportunities for staff hired
    directly
  • Quality Service Review- process to review quality
    of all providers of service, regardless if
    licensed or not

17
DMRS New Quality SystemWhy are we changing/what
are we doing?
  • DMR participated in the National Quality
    Inventory Project funded by CMS to identify the
    state of the states in quality assurance and
    improvement programs for HCBS services
  • To meet the requirements, must be able to
    demonstrate design, discovery, remediation and
    improvement functions are systematically in place
    and provide evidence
  • DMR identified weaknesses in the following domain
    areas
  • Participant access
  • Participant-centered service planning and
    delivery
  • Provider capacity and capabilities
  • Participant safeguards
  • Participant outcomes and satisfaction
  • System performance.

18
Quality Service Review
  • Five years in the making with the participation
    of private provider representatives
  • Built around answering if people are achieving
    positive, personal outcomes (17 of them in 6
    Focus Areas)
  • Incorporates the National Core Indicators
    consumer interview as a valid measure for
    consumer satisfaction, and to compare ourselves
    to other states nationally
  • Designed to collect performance and quality
    indicator data continuously during the normal
    course of business
  • Becomes the process of quality assurance and
    improvement for providers of all types of
    services
  • Should replace CLA licensing as we know it by
    incorporating CLA regulatory review into regional
    and system review activities.

19
QUALITY FRAMEWORK DMR INITIATIVES
  • Participant Safeguards
  • Risk and Safety Planning- risk and safety is
    assessed and interventions identified to promote
    health, independence and safety
  • Critical Incident Mgmt-
  • Housing and Environment- safety and security is
    assessed and modifications offered if needed
  • Behavior Interventions-used as last resort and
    with rigorous oversight
  • Medication Management- managed effectively
  • Natural and Public Emergencies- safeguards in
    place
  • Expanded health and safety screening
  • Include ISAs in Critical Incident Reporting
  • Work with families and consumers to find ways to
    implement safeguards while respecting privacy in
    peoples own homes
  • Develop new electronic incident reporting system
    to improve response and analysis

20
QUALITY FRAMEWORK DMR INITIATIVES
  • Rights and Responsibilities
  • Civic and Human Rights- informed and supported to
    exercise
  • Decision-making Authority- training and support
    provided to exercise authority
  • Due Process- informed and supported to exercise
    Medicaid rights
  • Grievances- informed and supported to file and
    seek resolution, and done so in a timely manner
  • Emphasize support to make decisions in
    person-centered planning process
  • Provide formal due process notice and information
    for DSS appeals
  • Collect due process and grievance data to analyze
    trends, and monitor timely resolution
  • Self-Advocacy Training Institute

21
QUALITY FRAMEWORK DMR INITIATIVES
  • Participant Outcomes and Satisfaction
  • Satisfaction- individuals and family members
    express satisfaction with their supports
  • Outcomes- services and supports lead to positive
    outcomes for each person
  • Quality System Review designed around achievement
    of Personal Outcomes
  • Incorporate National Core Indicators consumer
    interviews into QSR
  • Expand use of NCI family surveys by Providers to
    increase consistent collection of information
    about satisfaction

22
Purpose of the Core Indicators Project
  • Develop, field-test, and disseminate a nationally
    recognized set of PERFORMANCE INDICATORS that can
    be used in any state to gauge the effectiveness
    of specialized, publicly-funded DD services and
    supports
  • Establish corresponding NORMS AND STANDARDS as a
    basis for assessing and interpreting the
    indicators
  • Design a CONSUMER SURVEY instrument and protocol
    for assessing system performance through the eyes
    of individuals who receive and rely on state DD
    agency funded services and supports
  • Identify PRACTICAL APPROACHES for collecting,
    tracking and reporting the performance data in an
    economical and efficient manner.

The Core Indicators is entering its 6th year of
activity. Phase V reports on the results of
2002/03 (5th year).
23
Current Participating States
24
Why is Connecticut Participating?
  • To ESTABLISH BENCHMARKS for the departments
    performance objectives
  • To MEASURE THE EFFECTIVENESSof services and
    supports providedover time
  • To inform the departments STRATEGIC PLANNING
    process
  • To measure CONNECTICUTS PERFORMANCE nationally
    and against states with similar demographics
  • To INFLUENCE THE PROCESS and assure it is
    consistent with Connecticuts values and service
    delivery system.

25
QUALITY FRAMEWORK DMR INITIATIVES
  • CMS Quality Grant Award
  • Quality Councils and Quality Improvement
    Committees
  • Advisory Committees
  • Organizational Self-assessment for QI and
    Cultural Competency
  • Include individuals and families in provider
    review teams
  • DMR Cost standards
  • System Performance
  • System Performance Appraisal- state
    systematically engages in data collection and
    analysis of program performance and impact
  • Quality Improvement there is a systemic approach
    to continuous improvement of quality
  • Cultural Competency- effectively supports people
    of diverse cultural and ethnic backgrounds
  • Participant and Stakeholder
  • Involvement- have an active role in design,
    appraisal and QI activities
  • Financial Integrity- is assured

26
CMS Grants to States
  • Quality Assurance and Improvement for projects
    earmarked to improve states QA/QI systems
    consistent with the Quality Framework, and to
    meet the CMS quality assurance requirements for
    self-directed services under the Independence
    Plus waiver

27
CT Real Choice Grant
  • Quality Assurance and Improvement
  • Design a data management system to support QA/QI
    initiatives including the new Quality Service
    Review system, incident management system, and
    management of discovery, remediation and
    improvement activities
  • Develop quality indicators for individuals who
    live in their own or family homes
  • Develop self-advocacy knowledge of and
    participation in the quality system

28
Role of Advisory Committees
  • CMS Steering Committee
  • Provide guidance to DMR on the role of
    individuals, families and the community at large
    in the new Quality Review system
  • Participate in design methods to assess quality
    in individuals own or their familys home
  • Participate fully in the design of the research
    required to establish Level of Need and
    Individual Budgeting methods, and participate in
    the oversight of the sub-contractors performance
  • Provide guidance to DMR in the development of the
    Independence Plus Waiver
  • Provide guidance to DMR in the implementation of
    a system of individualized funding
  • Develop a plan to assure that the systems change
    funded by the grants are sustained beyond the
    term of the grants.

29
Role of Advisory Committees
  • Trades Meeting
  • A monthly meeting is held with the three Trades
    Associations and representatives of the private
    sector.
  • The agenda is developed in partnership
  • Share information regarding policy, budget,
    department initiatives, review procedural
    changes that impact private sector
    operations- Address questions and respond to
    concernsProvider Council
  • The Council has been in existence for four years
    with 18 designated members from the private and
    public sectors. Each Trade organization selects
    three standing members
  • Issues are referred by the Trades meeting group.
    Issues are selected that
  • Require more in-depth discussion for meaningful
    provider inputRequire a collaborative approach
    to develop policies or proceduresRequire
    analysis and feedback or recommendations to the
    Trades meeting.

30
Role of Advisory Committees
Regional Advisory Committees
  • Comprised of individuals, family members,
    community representatives, and advocacy
    organizations
  • Provide advice and recommendations to the
    regional director regarding initiatives
  • Independent review of quality data and make
    recommendations for improvement

State Quality Improvement Committee Review
state and system quality data and analysis,
recommend improvement initiatives, and monitor
compliance. Composition to include all
stakeholders. Begin 2005.
31
(No Transcript)
32
What Does it Look Like to the Individual/Family?
33
Our Goals and Vision
  • Further self-determination allowing consumers and
    families to control their resources, design their
    own supports and choose those who serve them
  • Enhance family and individual support
  • Reduce our reliance on traditional services
  • Reduce the size of our public operations using
    our staffs expertise to operate specialized
    supports
  • Find ways to serve those who are un-served or
    underserved
  • Fairly allocate and distribute the resources of
    the department to meet the needs of our consumers
  • Ensure the health and safety of our consumers and
    safeguard against risk
  • Develop consistent practice.

All to improve the QUALITY of our service
delivery system.
34
The End
About PowerShow.com