Transcript Waiver Review Initiative

2013 Minnesota Age & Disabilities Odyssey
June 17, 2013
WAIVER REVIEW INITIATIVE
Using Data to Drive Improvements
Today’s Agenda:
• Purpose of the Waiver Review Initiative
• Waiver Review Round II
• Findings & Best Practices for Better Results
• Using WR Data to Drive DHS Improvements
• Concluding Items
Purpose:
• Goals
• History
Goals:
• Supports CCA vision and strategic plan
• Helps ensure that the long term care
programs continue and are sustainable
over time.
• Helps ensure that long term care
programs improve the quality of life of
Minnesotans.
Goals:
• Assure compliance by lead agencies with
federal and state requirements.
• Identify best practices and/or barriers,
track local improvements, and share best
practices amongst lead agencies.
• Obtain feedback about DHS resources.
History:
• Waiver Review Initiative began in 2006 and
reviews of 89 lead agencies, including 87
counties and two tribes, completed in early
2012.
• Waiver Review Initiative – Round II began in
April 2012 and will be completed in 2015.
• DHS continues to partner with the Improve
Group.
Waiver Review Round II
• Tools & Methods
• Enhanced Focus on Quality Improvement
• Sharing Performance Data with Lead Agencies
Tools & Methods of Analysis:
• The waiver review process uses a
comprehensive, mixed-method approach.
• The data collection methods are intended
to glean supporting information, so that
recommendations and corrective actions
are supported by multiple sources of data.
• The data collected is analyzed and the
findings are put in a report for each agency.
All reports and the LAs’ responses are
posted on the DHS website.
Data source
Purpose
Lead Agency Program
Summary data (MMIS/MAXIS)
Compares LA to State averages and those of similar LAs
for several operational indicators.
Participant case files
Identifies compliance with program requirements and
assesses quality of assessment, care plans, and case
management.
Provider survey
Gathers feedback on LA strengths, areas for improvement,
and LA communication with providers.
Quality Assurance Plan (QA)
survey
Gathers information about LA compliance with state and
federal requirements, quality assurance activities, and
policies/practices related to health and safety.
Case manager focus group
Discusses trends, barriers and opportunities within
community and explores practices that could be adapted
by other LAs.
Supervisor interview(s)
Discusses agency policies and procedures for HCBS
Waiver program administration.
Supervisor meeting
Discuss county’s results from the QA and provider surveys
Focus on Quality Improvement:
Examination of qualitative factors
during case file review
• Moving from “compliant” to “best practices”
to improve quality of care for waiver
participants:
• LTCC/Screenings, Care Plans (CSP/ISP),
and Case Notes/Documentation
Focus on Quality Improvement:
Case specific list of non-compliant
case file documentation
• Improving our ability to track remediation
for CMS.
• 100% of non-compliant cases reviewed onsite must be corrected in 60 days.
• Allows LAs to see which programs and
which staff may need additional supports.
Focus on Quality Improvement:
Project website created to share lead
agency resources and best practices
• Similar size LAs have similar strengths and
barriers.
• Allows for easy access to share LA documents
and information considered “best practices”
www.Minnesota.HCBS.info
Focus on Quality Improvement:
Increased availability of county
specific performance data
• Promote internal QA and monitoring of
compliance.
• New data sets being created and shared
based on LA requests:
• Earned income data
• Participant needs vs. Residential settings
Focus on Quality Improvement:
• Reports available include:
• Average LTC spending per person
• Percent of LTC spending in HCBS
• Percent of people who receive HCBS
• Percent of people who receive HCBS at home
• Percent of people with low needs with waiver services in a residential setting
• Percent of people with high needs
• Percent of people with high needs who receive services at home
• Working-age people with monthly earnings
• Working-age people earning $250 or more per month
• Percent of nursing facility resident days for people with low needs
• Housing type at initial or last assessment
• Initial assessments or screenings completed on time
http://www.dhs.state.mn.us/main/idcplg?IdcService=GET_
DYNAMIC_CONVERSION&RevisionSelectionMethod=La
testReleased&dDocName=dhs16_144803
Sharing Performance Data:
Sharing Performance Data:
• Discussion with lead agency about what is
driving its outcomes or results
• Comparison of lead agency to its cohort
and statewide data
• Let’s review an example: Handout from
Wright County
Findings & Best Practices:
• Case Management
• Assessment & Care Planning
• Case File Technical Compliance
• Internal & External Relationships
• Provider Service Capacity & Development
• Waiver Allocations
Case Management:
Data:
• Case managers visited participants 3.6 times
in the 18 months prior to the waiver review.
• Nearly half (48%) of providers indicated that a
top strength of the lead agency they work with
is good, open communication between case
managers, consumers, and providers.
Case Management:
Recommendation for Better Results:
• Frequent visits and contacts with
participants and their families allows a case
manager to build strong relationships and
monitor health and safety needs.
Assessment & Care Planning:
Data:
• 78% of care plans reviewed contained the
required health and safety information.
• 87% of care plans provided information on the
services the participant was receiving to
address their needs.
• 98% of care plans were current at the time of
review, and 96% were signed by the
participant and/or guardian.
Assessment & Care Planning:
Assessment & Care Planning:
Recommendation for Better Results:
• Reminder: CSP/ISP is the only document
the participant receives. It should be
person-centered, outline his/her needs and
how services will address those needs, and
use clear language.
• Consider developing a single care plan for
CADI waiver participants also receiving
Rule 79 MH TCM that includes all the
required elements.
Case File Compliance:
Data:
• The areas where lead agencies were
frequently found to be compliant are
• DD screening documents are current
(98%),
• OBRA Level One document (99%),
• Choice questions are answered by
participants (95%).
Case File Compliance:
Recommendation for Better Results:
•LA’s that incorporate other requirements
into the care plan are more likely to be
compliant (e.g. the DD ISP includes
information on one’s rights to appeal).
•LA’s who use standard formats for all
documents across programs are more likely
to have all required documents in place
Case File Compliance
• Corrective Actions are issued when
patterns of non-compliance are found.
• For example all CADI cases are missing a back
up plan
• LAs are required to develop a corrective
action plan to resolve the issue for all cases.
• Corrective action Results from year one…..
Corrective Action Issued
Person informed of right to appeal
documentation in the case file
Person informed of privacy practice
(HIPAA) documentation in the case
file
Timeliness of LTCC Assessment
Back-up plan (CCB only)
Frequency of visits as required by
program
Participant needs identified in care
plan
Informed consent to release
information documentation in the
case file
Health and safety issues outlined in
care plan
Related conditions checklist in case
file (DD only)
Participant outcomes & goals stated
in individual care plan
Care plan signed and dated by all
relevant parties
N of Lead Agencies
Receiving Corrective Action
% of Lead Agencies
Receiving Corrective Action
18
75%
13
54%
12
7
50%
29%
7
29%
6
25%
5
21%
5
21%
5
21%
4
17%
3
13%
Internal & External Relationships:
Data:
• A majority of LAs (88%) indicated in the QA
survey that they always have case managers
document provider performance, and always
provide oversight to providers on a systematic
basis (75%).
• 76% of providers surveyed indicated they submit
monitoring reports to the lead agency, and 83%
indicated that they received the needed
assistance when it was requested from the lead
agency most or all of the time.
Internal & External Relationships:
Recommendation for Better Results:
• Use visit sheets to document satisfaction
and to monitor provider performance to
ensure consistency across programs.
Service Capacity & Development:
Data:
• 75% of LAs said that they recruit service
providers to address gaps by working with
existing providers or use of RFPs.
• Common service gaps for LAs: providers of
specialized services including psychiatry, crisis
beds, dental, and transportation.
• 12% of Provider Survey respondents indicated
increased opportunities for community based
employment as a service need (3rd overall).
Service Capacity & Development:
Recommendation for Better Results:
• Partner to increase purchasing power.
• Develop in-home service packages to move
low needs participants out of CFCs and
repurpose those beds for high behavioral
participants.
• Expand community-based employment
opportunities for participants with disabilities,
that results in higher wages in CCB and DD.
Waiver Allocations:
Data:Program
DD
CCB
3% or
less
4% to
6%
7% to
10%
10% to
15%
16% or
more
2
1
5
4
10
7
6
5
1
7
Recommendation for Better Results:
• 10 of 24 LAs received recommendation to
reduce their reserve.
• Include accounting staff on team to provide
added analysis above and beyond WMS,
allowing LAs to manage more closely.
Waiver Review Data Driving
DHS Improvements:
• Using data to improve CCA
• Feedback on DHS
DHS Improvements:
• Requests from lead agencies: Model
contract changes
• Waiver Review Team observations during
reviews: CDCS care plan components
• Data analysis of case file results:
• QET
• Technical assistance DHS provide to LA’s
• Reports to CMS
Feedback on DHS:
• Supervisors and case managers are asked
to share feedback on DHS tools and
resources.
• 278 case managers
• 92 supervisors
• Sharing results within CCA to prompt state
improvements and better serve LAs.
Case manager feedback on DHS
DHS Resource
Case
Managers
Rating
N
1-2
3
4-5
E-Docs
219
10%
15%
76%
Senior Linkage Line
159
9%
20%
71%
Disability Linkage Line
122
11%
20%
69%
Disabilities Service Program Manual
160
10%
22%
68%
Ombudsmen
153
12%
29%
59%
Help Desk
155
18%
25%
57%
Bulletins
233
15%
36%
49%
DB101.org
15
40%
13%
47%
Listserv announcements
124
14%
40%
46%
MinnesotaHelp.Info
99
28%
25%
46%
Regional Resource Specialist
147
25%
31%
43%
DHS website
233
22%
37%
42%
Videoconference trainings
214
22%
36%
41%
Webinars
197
26%
35%
40%
Policy Quest
100
37%
23%
40%
Concluding Items:
• Q&A
• Resources
• Contact Information
Q& A:
Discussion Questions:
• How do these issues or measures align with
what you see in your community?
• What additional information would be helpful
for DHS to share with LAs?
• Was your Waiver Review experience
informative and did it prompt any changes at
the LA?
Resources:
• Waiver Review Project Website:
www.MinnesotaHCBS.info
• DHS Waiver Review Initiative – Lead
Agency Reports:
http://www.dhs.state.mn.us/main/idcplg?IdcService=G
ET_DYNAMIC_CONVERSION&RevisionSelectionM
ethod=LatestReleased&dDocName=dhs16_136600
• DHS CCA Performance Reports:
http://www.dhs.state.mn.us/main/idcplg?IdcService=G
ET_DYNAMIC_CONVERSION&RevisionSelectionM
ethod=LatestReleased&dDocName=dhs16_144803
Contact Information:
Jean Martin, DHS
[email protected]
651.431.2578
Julia Wallis Holmoe, DHS
[email protected]
651.431.2168