MFP Quality Requirements August 15, 2012

NQE Consortium Members: Agenda Review the elements and monitoring processes for each of the MFP quality requirements Review data needed to complete the MFP Semi-Annual Report State perspectives from MFP colleagues Discussion and questions NQE Consortium Members: Truven Health Analytics Human Services Research Institute Boston College National Resource Center for Participant-Directed Services National Quality Enterprise - Grant Funded by CMS

MFP Quality Requirements Quality Improvement Strategy - Consistent with the 1915(c) quality requirements Critical Incident Reporting and Management System* 24-Hour Backup Strategy* Risk Assessment and Mitigation Protocol* *Monitoring process to ensure that systems/protocols are working as planned National Quality Enterprise - Grant Funded by CMS

MFP Quality Requirements Quality Improvement Strategy Critical Incident Reporting and Management 24-hr Backup Strategy Risk Assessment and Mitigation MFP Participant National Quality Enterprise - Grant Funded by CMS

Why Additional MFP Quality Requirements? Vulnerable population Dependence on institutionally-based care Potentially little connection to the community Transitioning presents unique challenges Variety of populations with a variety of needs Wide variety of available housing and community supports National Quality Enterprise - Grant Funded by CMS

1915(c) Quality Improvement Strategy QIS must meet 1915c quality requirements 1915c HCBS waiver application Applies to all programs and services serving MFP participants including: HCBS services Demonstration services Supplemental services State Plan services National Quality Enterprise - Grant Funded by CMS

1915(c) QIS – Required Elements Performance measures Demonstrate whether the state is meeting the assurances Remediation strategies Take actions to fix or address non-compliance Trending and Analysis Identify trends and areas in need of improvement Quality Improvement Initiatives Carry out quality improvement initiatives/projects Evaluate their effectiveness National Quality Enterprise - Grant Funded by CMS

Risk Assessment and Mitigation Written plan for each MFP participant that: Identifies risks in transitioning to the community, and Outlines how these risks will be/are being addressed/mitigated National Quality Enterprise - Grant Funded by CMS

Risk Assessment and Mitigation Define potential risks Health risks Behavioral/mental health risks Stability of the informal caregiver system Address the identified risk in the comprehensive service plan National Quality Enterprise - Grant Funded by CMS

Risk Assessment and Mitigation - Monitoring Process How will you know that this process is working as planned? Are risk assessments being conducted? Are risk plans adequate and appropriate? Are risk plans implemented and monitored by the case managers and transition coordinators (if appropriate)? Are risk plans revised as risks change? Who will take action if remediation is needed? National Quality Enterprise - Grant Funded by CMS

National Quality Enterprise - Grant Funded by CMS 24-Hour Backup Each MFP participant must have an individualized backup plan in place to respond to and address: Any lapse in essential services, and Other circumstances that could have a negative effect on a participant’s health or welfare. National Quality Enterprise - Grant Funded by CMS

Elements of a 24-Hour Backup Strategy Individual backup plan mechanisms may include: Provider(s) that agree to respond 24/7 Informal supports available to respond 24/7 Access to live person 24/7 (e.g. on call case manager) Other agreed-upon resources Plans may vary for different populations, service delivery systems, models or geographic locations National Quality Enterprise - Grant Funded by CMS

24-Hour Backup – Monitoring Process How will you know that the process is working as planned? Do all MFP participants have a 24/7 backup plan? Are these plans adequate and appropriate? Are plans revised as needed? Who will take action if remediation is needed? National Quality Enterprise - Grant Funded by CMS

Critical Incidents and Reporting System (CIRS) System to report incidents on MFP participants and track resolution If MFP will be included in state’s current CIRS, it must be able to separately track and report on MFP participants Major components states must describe in their Operational Protocol: Reporting requirements (e.g., types of incidents, reporting authority, required reporters, reporting timeframes) Training/education to participants and others (as appropriate) on abuse, neglect and exploitation reporting Responsible entity and process for reviewing (e.g., investigation) critical incidents State agency/process for incident management system oversight National Quality Enterprise - Grant Funded by CMS

CIRS–Required Elements How will the state know that CIRS processes are working as intended? Which state agency (or agencies) will be responsible for overseeing the reporting of and response to critical incidents? Who will review critical incidents and act upon them in the event that remediation/improvement is needed? Will the monitoring approach differ across populations? National Quality Enterprise - Grant Funded by CMS

National Quality Enterprise - Grant Funded by CMS System Improvement For all 3 Additional Quality Requirements: Critical Incident Reporting and Management System 24-Hour Backup Strategy Risk Assessment and Mitigation Protocol System Improvement Identify trends and areas in need of improvement Carry out quality improvement initiatives/projects Evaluate effectiveness of initiatives/projects National Quality Enterprise - Grant Funded by CMS

MFP Semi-Annual Report Quality section of the MFP Semi-Annual Report to CMS includes: Improvements and Challenges Use and responsiveness of the 24-hour backup system Findings of critical incidents reports National Quality Enterprise - Grant Funded by CMS

MFP Semi-Annual Report - QIS Notable improvements with the HCBS quality management system Significant challenges related to: Discovery Remediation Improvement National Quality Enterprise - Grant Funded by CMS

MFP Semi-Annual Report – 24-Hour Backup Use and responsiveness of the 24-hour backup By population Elderly; MR/DD; MI; PD; IMD/Chronic Hospital By type of assistance needed Transportation to medical appointment Life support equipment repair/replacement Critical Health Services Direct service/support workers not showing up Other National Quality Enterprise - Grant Funded by CMS

MFP Semi-Annual Report - CIRS Findings of critical incidents reports Abuse , Neglect, Exploitation Hospitalizations, Emergency Room Visits How many occurred within 30 days of discharge from a hospital or other institutional setting? Deaths due to abuse, neglect, or exploitation Death due to breakdown in the 24-hour backup system Involvement with the criminal justice system Medication Errors Other National Quality Enterprise - Grant Funded by CMS

MFP Semi-Annual Report - CIRS What was the result of investigation(s) of incident(s)? Did the state make changes, either for the consumer(s) or its system, as a result of the analysis of critical incidents? National Quality Enterprise - Grant Funded by CMS

National Quality Enterprise - Grant Funded by CMS State Perspectives Jake Reuter, North Dakota MFP Project Director jwreuter@nd.gov Risk Assessment and Mitigation Process Darrell Curtis, MFP Project Director (Louisiana) darrell.curtis@la.gov Critical Incident Reporting and Management National Quality Enterprise - Grant Funded by CMS

National Quality Enterprise - Grant Funded by CMS State Resources North Dakota’s Money Follows the Person Project http://www.nd.gov/dhs/info/pubs/mfp.html Louisiana’s Money Follows the Person Project www.myplacelouisiana.org National Quality Enterprise - Grant Funded by CMS

Questions? The National HCBS Quality Enterprise Website http://www.nationalqualityenterprise.net National Quality Enterprise - Grant Funded by CMS