Transcript Quality Management Strategy Overview and Administrative

Quality Management
Office of Long Term Living
Quality Management, Metrics &
Analytics
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Agenda
Metrics & Analytics
Assurances:
 Qualified Providers
 LOC Assurances
 Service Plans
 Health & Welfare
 Financial
 Administrative
 QIS
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Metrics and Analytics
Division
Mission and Functions
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Division Mission
Provide timely and accurate reporting and
analyses for decision makers in support of
the overall goals and objectives of the PA
Department of Aging and Office of Long
Term Living. Administer the Social
Assistance Management System (SAMS)
and Omnia in support of the Aging
Network to assure data integrity for Aging
and NHT Programs and Operations.
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Division Functions

Provide cost and effectiveness analyses of current
programs, proposed modifications to current programs
and new programs
 Provide census and demographic data support for
PDA/OLTL
 Prepare or assist program offices in preparation of
mandatory state and federal reports e.g. CMS 372
Reports, NAPIS Report
 Support QM with samples, surveys and reports for
annual assurances
 Support QM in the design, implementation,
administration and use of QMMU Monitoring Database
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Division Functions (cont’d)

Prepare Benchmarking reports and Dashboards to
support ongoing evaluations of AAA’s, Providers and
Waiver Program operations and Aging Programs
 Provide Administration, Technical and User Support for
SAMS and Omnia
 Develop, prepare and publish procedures for
implementation of new programs and policies in SAMS
 Prepare and conduct training for SAMS and Omnia
users – On-site, Webinars, etc.
 Design and implement new Assessment Forms,
modify existing forms as required
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Division Functions (cont’d)
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Represent PDA/OLTL needs and interests
regarding Information Technology issues
Test and evaluate new versions of SAMS,
Omnia and HCSIS
Test and evaluate SAMS, Omnia, and DPW
Enterprise Data Warehouses for data integrity
Survey design and analysis support
Provide technical database and report creation
support for PDA/OLTL Bureaus
Develop an integrated Incident, Complaint,
Hearings and Appeals Database and Reporting
System
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Management Reports
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Performance Reports - Consumers served, units
delivered, dollars expended, etc
Demographic Reports – Consumer and provider
characteristics
Scorecard – Measures compared to established
targets
Outcomes Analyses – What you got for what you
spent
PDA/OLTL Custom Reports System – Library of
reports for service models utilizing SAMS and Omnia
EDW Reports - Library of reports for service models
utilizing HCSIS
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Quality Management, Metrics
and Analytics
Data Collection
and Reporting Section
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Objective
Provide the OLTL Network with
Training, Technical Assistance
and Resource Material to
enhance the skills of 2,000
plus SAMS/OMNIA Users in
order to promote quality and
accurate data entry
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SAMS/OMNIA
1.
2.
Two separate Databases. OMNIA
serve as the repository for
assessments and SAMS serves as
the repository for demographics,
service programs and service
delivery information.
Each case record within the
databases are automated clinical
records.
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The OLTL Network
1.
2.
3.
4.
5.
6.
7.
Assessors
Care Managers/Service
Coordinators
Protective Service Workers
SAMS Administrators
Network Supervisors
Network Administrators
Over and Under 60 NHT Transition
Coordinators
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Resources Provided
to the Network
1.
2.
3.
4.
5.
Webinars
Training Manuals
Videos
Dashboards
Ad Hoc Requests
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Where the Resource
Material is Located
1.
2.
3.
Unsecured FTP Site for access
by the AAA Network
Allshare Drive (S:) Drive for
access by PDA and OLTL staff
OLTL Website
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Qualified Providers Assurance
QMET Update
Current Monitoring Status & Waiver
Standards Review
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Current Monitoring Status
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The QMET has completed all monitoring visits
of HCBS providers to date (328). In addition to
waiver provider visits QMET has completed:
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Abbreviated On-Site Monitoring Visits
36 F/EA On-Site Reviews
100 follow up visits
150 StIPS
Remaining Standards Implementation Plans
are being completed and approved with follow
up of plans being scheduled
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What is QMET looking at?
The current services agencies are
providing to consumers against the
standards outlined in the Waiver
Reference Guide.
 The F/EA standards as currently
approved
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Where are the QMETs finding?
Overall compliance with the waiver
program standards is excellent.
 Most commonly missed standards are
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Distributing hotline number to consumers
 Incident reporting was inconsistent with
waiver requirements
 Billing/ Bookkeeping Errors
 Documentation
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What’s Next for the QMETs?
Review of the waiver monitoring tool and
provider letter
 Continue scheduling of on-site
monitorings
 Follow up of Corrective Action Plans
(StIPS)
 Clarify how providers are expected to
monitoring their subcontractors
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QMET Resources
The Waiver Reference Guide and FEA
standards can be found at
 http://www.dpw.state.pa.us/PartnersProvi
ders/PMQ/QMMA/QMET/QMETResourc
es/
Or
Type “QMET Resources” into your favorite
search engine
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Level of Care Assurance
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Level of Care
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Based on the review of the data from the
past 24 months on the Level of Care
performance measures the following
changes are being submitted to CMS in
the required 372 documents regarding
remediation:
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Level of Care Next Steps
The performance measure for subassurance a.i.c is being clarified to more
accurately reflect the information being
tracked and trended.
 The frequency of the reports being run
for sub-assurance a.i.a is being changed
to every 8 weeks.
 Remediation is being clarified to more
accurately reflect current OLTL process.
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What Does this Mean to You?
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As a participant, advocate or stakeholder
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As a Provider of enrollment, level of care
assessment or supports
coordination/care management

OLTL
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Service Plan Assurance
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Service Plan Assurance
QMMA and BIS implemented the
standardized Individual Service Plan in
October 2010
 Training on the new forms and
processes were completed prior to
implementation and remain on going as
needed
 Mailing/analysis of consumer satisfaction
surveys has started.
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What does this mean to you?….
Service Plans
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Providers and OLTL staff can expect
training on new forms and processes for
service plans to be on going as needed
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Participants can expect consistent forms
and processes will be used across the
state
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Satisfaction Surveys
 One
Survey for all Waivers
 Reduce Mailings and Participant
Intrusion
 Gather Similar Facts on each Waiver
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On Going Survey Review
 Review
of survey questions wording for
understanding
 Add questions based on need for more
information
 Results are one component for
determining that all participant needs
are met and services are received
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Mailing Cycles for Satisfaction Surveys (New
Participants / Ongoing Participants)
Mailings will be every 4 months
 Every 4 months waiver participants who
enrolled in that time period will receive a
survey
 Every 6 months participants who have
received HCBS waiver services for over
one year will receive an Annual survey
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Participant Satisfaction Surveys
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New questions will be added to surveys
for Health and Welfare Assurance as
needed to gather appropriate
information. Such as:
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“I know how to report abuse, neglect, or
exploitation including the use of restraints
and other restrictions.”
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What does this mean for you?….
Surveys
 QMU staff will answer questions about
the survey and analyze responses
 Providers may receive questions about
the surveys
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Refer questions to Helpline (1-800-757-5042)
Participants may receive a survey in the
mail
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Complete survey & return in postage paid envelope
Contact Helpline if have questions (1-800-7575042)
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Health & Welfare Assurance
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Health & Welfare Assurance Update
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Operational Functions
Incident Data for All Waivers available for
OLTL use
 Quality Assurance Helpline
 Quality Assurance Helpline Database
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Clarification and revision of Performance
Measures
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HW ~ OLTL Helpline Numbers
General Information – 1 (866) 286-3636
Information on OLTL programs
Enrolled Participants – 1(800) 757-5042
Concerns/complaints with Home and
Community Based services
Provider Assistance – 1 (800) 932-0939
Billing inquiries, issues, claims processing
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What does this mean to you?....
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Providers document incidents and may be contacted
for additional information during the investigation of
complaints and incidents. Remediation actions may
be required of providers.
OLTL staff document and research complaints and
incidents, including documentation of the resolution.
Participants or their representative's use the 800 line
to report complaints and issues they are unable to
resolve at the local level. Participants may be
contacted to discuss complaints or incidents.
Final OLTL Incident policy under development
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Financial Accountability
Assurance
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Financial Accountability Assurance
Paid Claims Review report
 No claims paying with incorrect
procedure codes
 Bureau of Provider Support developing
internal protocols for remediation which
can include recoupment
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Financial Accountability Assurance
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Quality Management and Efficiency
Teams (QMET) Provider Claims Review
Probe sampling of claims
 All Provider reviews completed, those out of
compliance are correcting issues via a
Standards Implementation Plan, (StIP).
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What does this mean for you?….
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Provider, OLTL BPS staff and BFO staff
notified if billing errors discovered
through financial report or QMET review
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Correction(s) initiated for identified issues
and to prevent reoccurence
Participants responsible for correct
authorization of time sheets
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Administrative Authority
Assurance
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Administrative Authority Assurance
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As reported by the QMEU
30 Policies or Directives have been initiated
since 01/01/2009, including:
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Interim Incident Management Procedures for the
Aging Waiver (APD 09-01-01)
Nursing Facility Clinically Eligible (NFCE)
Clarification (APD 09-01-02)
PDA Contract Procurement Requirements for Area
Agencies on Aging (APD 09-01-03)
Provider Rates for Services funded through the
OBRA, Independence, and COMMCARE Waivers
(various #s)
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What does this mean for you?…..
Providers and all OLTL staff need to
obtain, review and implement policies as
applicable.
 Participants need to be aware that new
policies may be issued at any time
impacting the waiver and their services.
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Quality Improvement Strategy
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Quality Improvement

QMU monitors waiver basics
Enrollment
 Length of time for enrollment
 Length of time for start of services
 Will continue to add new focus areas
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QMU will continue to monitor some
performance measures after they are
replaced
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QIS Enhancements
QIS expected to change
 Changes to quality sections of approved
1915(c) waiver applications
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Listed on annual CMS 372 reports
 Deletion of 2 performance measures
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AA – % new policy monitored and remediated by
non state entities
 HW – # providers who fail to report incidents
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OLTL Quality Council
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First meeting was an orientation meeting held
in June 2009
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First official meeting was held in August 2009
 Comprised of Participants, Participants Family
Members, Provider Agencies, AAA’s, Aging
Community Representatives, OLTL Staff
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Quality Council
Meetings since have been held quarterly
in the months of February, May, August,
and November.
 Minutes and information are posted on
the website.
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What does this mean for you?…..
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Providers and OLTL staff may notice new
reports, remediation and system improvement
efforts that are not strictly related to the CMS
Assurances
 Participants may experience increased quality
of services and service delivery due to
remediation and system improvements
 Everyone can follow the Quality Council
activities on the website.
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Questions
Questions
Questions
Questions
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