Contract Accountability & Oversight Quality Assurance Authority Reviews

FY 2018 Trends Quality Assurance Texas Home Living Home & Community-based Services PASRR 8/30/2019

Quality Assurance State-Wide Averages 8/30/2019

Quality Assurance State-Wide Trends Includes Performance Contract, General Revenue and Community First Choice All Review Sections were above 90% except for 2 Data-79.37% Additional Items of No-Compliance- 43.75% 8/30/2019

Quality Assurance Data-79.37% 11 LIDDAs-R0NR and R0NF assignment inaccuracies in CARE 2 LIDDAs-Critical Incidents and/or CANRS Reporting 8/30/2019

Quality Assurance Additional Items-43.75% 8 LIDDAs-PHI Violations 2 LIDDAs-Reporting allegations of A/N 1 LIDDA-Managing a Transfer/Concern Resolution 1 LIDDA-Rights Restriction 8/30/2019

TxHmL State-Wide Averages 8/30/2019

TxHmL State-Wide Trends All but 2 Elements were above 90% Service Coordinator Assurances-86.39%-38 LIDDAs had findings in this area Guardianship-86.0%-8 LIDDAs had findings in this area 8/30/2019

Most Common Findings in TxHmL Service Coordinator Assurances Discovery & Person Directed Planning Developing & Implementing PDP IPC Development Monitoring Services Reporting Progress Toward Outcomes 8/30/2019

Service Coordination Assurances Discovery & Person Directed Planning Only 2 LIDDAs had findings in this area 8/30/2019

Service Coordination Assurances Developing & Implementing a PDP-38 LIDDAs Outcomes are service statements-30 LIDDAs Outcomes are not developed-5 LIDDAs Services are not included-16 LIDDAs Outcomes are not supported by discovery-23 LIDDAs 8/30/2019

Service Coordination Assurances IPC Development 8 LIDDAs had findings in this area 8/30/2019

Service Coordination Assurances Monitoring Services Monitoring delivery & satisfaction with services-37 LIDDAs Making face-to-face contact-16 LIDDAs 8/30/2019

Service Coordination Assurances Reporting Progress Toward Outcomes 37 LIDDAs had findings in this area 8/30/2019

HCS State-Wide Averages 8/30/2019

HCS State-Wide Trends All but 3 Elements were above 90% Person/Family Directed Planning-87.08%-32 LIDDAs had findings in this area Service Coordination Monitoring-79.60%-39 LIDDAs had findings in this area Program Specific Training-89.47%-2 LIDDAs had findings in this area 8/30/2019

Most Common Findings in HCS Person/Family Directed Planning Outcomes are Service Statements-29 LIDDAs Outcomes are not supported by discovery/not person-centered-32 LIDDAs 8/30/2019

Most Common Findings in HCS Service Coordination Monitoring Monitoring delivery of and satisfaction with services-39 LIDDAs Face-to-face Contact-8 LIDDAs Reporting Progress Toward Outcomes- 39 LIDDAs 8/30/2019

PASRR State-Wide Averages 8/30/2019

PASRR State-Wide Averages (continued) 8/30/2019

PASRR State-Wide Trends Top 10 Findings Based on Average Scores Across all LIDDAs Top 5 Findings Based on Number of LIDDAs with Findings 8/30/2019

Top 10 Findings in PASRR Based on Average Scores And Based on Number of LIDDAs with Findings 8/30/2019

#10 Pre-Move Site Review - 17.503 (d) (Ave score of 80.30%) # LIDDAs Finding 11 No evidence Service Coordinator conducted Pre-Move Site Review before individual transitioned from Nursing Facility to community 3 No evidence Service Coordinator reviewed Essential Supports listed on Diversion plan in Pre-move Site Review 8/30/2019

#9 Post-Move Monitoring – 17.503(f) (Ave score of 80.14%) # LIDDAs Finding 15 No evidence first, second, or third post move monitoring visits were completed within the required timeframe 13 No evidence Service Coordinator addressed essential supports, identified gaps in care, or addressed gaps to reduce potential risks during first, second, or third post-move monitoring visits 8/30/2019

#8 Coordination with Nursing Care Plan – 17. 502(7) (Ave score of 79 # LIDDAs Finding 17 No evidence information in Nursing Facility Care Plan was coordinated with ISP 8/30/2019

#7 Comprehensive Care Plan – 17.501 (b) (2) (D) (Ave score of 74.85%) # LIDDAs Finding 18 Outcomes for Specialized Therapies in the ISP were different than the outcomes in the NF Therapy Plans 9 No copy of Care Plan in record and no documented efforts to obtain the Care Plan 6 NF Plan of Care in the record not the most current Plan of Care 3 Most current NF Care Plan was not in record until week of CAO Review. 8/30/2019

#6 Community Living Options – 17.501 (b)(2)(A) Ave score of 73.94%) #LIDDAs Finding 29 No evidence CLO was provided within the required timeframe 6 No evidence CLO was presented to the individual 4 No evidence community living options were provided when conducting the PE for persons diverting from nursing facility No evidence CLO was presented at least annually to persons refusing service coordination 3 No evidence CLO was provided at the Service Coordinator's first face-to-face contact 8/30/2019

#5 Coordination and Monitoring of Services – 17 #5 Coordination and Monitoring of Services – 17.502(3) (Ave score of 67.15%) #LIDDAs Finding 33 No evidence of reporting progress/lack of progress towards outcomes during the quarters of the ISP 18 No evidence delivery of or satisfaction with services was monitored with individual/LAR during quarter of ISP 17 No documented attempts to coordinate PASRR Specialized Services or to obtain outcomes for services from NF staff 4 No evidence of frequency, amount, or duration of the specialized services 2 No evidence that Form 1016 SPT PASRR Specialized Services Discussion Checklist was completed in conjunction with SPT meeting. 8/30/2019

#4 Guardianship – (Ave score of 62.65%) #LIDDAs Finding 5 No evidence of current letter of guardianship in record or of request for updated copy 9 No evidence of SPT discussion regarding possible guardianship referrals when needed 8/30/2019

#3 Transition Planning – 17.503 (a) (Ave score of 54.35%) #LIDDAs Finding 8 No evidence Service Coordinator completed transition plan as required 2 No evidence Service Coordinator addressed concerns about community living 8/30/2019

#2 Coordination of Specialized Services – 17 #2 Coordination of Specialized Services – 17.501 (b)(2)(B) (Ave score of 53.16%) #LIDDAs Finding 23 No evidence of PASRR Specialized Services Form being completed 14 PSS forms for the SPTs did not reflect information in ISPs 12 No evidence PASRR Specialized Services Form was entered into TMHP timely for SPT meeting 2 LIDDA specialized service was agreed upon by SPT and added to initial PSS form, but referral for specialized services was not initiated-no evidence Service Coordinator facilitated coordination of this service in a timely manner No evidence CLO Form 1039 was completed when CLO was presented 8/30/2019

#1 ISP Revisions – 17.501 (b)(1)(D) (Ave score of 50.48%) #LIDDAs Finding 26 Specialized services not added to ISP/ISP not updated 3 No discussion of PASRR Specialized Services 8/30/2019

Top 5 Findings in PASRR Based on Number of LIDDAs with Findings How many LIDDAs had one or more findings for each element? 8/30/2019

#5 Individual Service Plan 17.502 (2)(c) Identifying Specialized Services – 28 of 39 LIDDAs had one or more findings 8/30/2019

#4 Attachment A-4 Nursing Facility Transitions 17.501 (b)(2)(B) Coordination of Specialized Services – 31 of 39 LIDDAs had one or more findings *This was #2 for average scores 17.501 (b)(2) (A) Community Living Options – 30 of 39 LIDDAs had one or more findings *This was #6 for average scores 17.501 (b)(1)(D) Revision of ISP – 29 of 39 LIDDAs had one or more findings *This was #1 for average scores 8/30/2019

#3 Individual Service Plan 17.502(2) (a) Person-Centered Approach – 34 of 39 LIDDAs had one or more findings 17.502 (2)(b) ISP Content – 32 of 39 LIDDAs had one or more findings 17.502 (4) Integrated Activities – *This was #7 for average scores 8/30/2019

#2 Monitoring and Coordination of ISP 17.502(3) Documenting Progress - 35 of 39 LIDDAs had one or more findings *This was #5 for average scores 8/30/2019

#1 Attachment A-4 Nursing Facility Transitions 17.501 (b)(1)(B) Service Planning Team Meeting- 38 of 39 LIDDAs had one or more findings *This was #2 for average scores Attachment A-4, 1.5 Service Planning Team (1) (A-H) SPT Membership Requirements - 35 of 39 LIDDAs had one or more findings 8/30/2019

Summary Overall Averages Across Programs Program FY 2017 FY 2018 Quality Assurance 93.10% 97.16% TxHmL 86.51% 89.36% HCS 87.79% 87.68% PASRR 89.05% 84.08% 8/30/2019

Outcomes State-Wide training will soon be developed to provide more information on outcomes CAO, Curriculum Developers, and Person-Centered Trainers concur that Outcomes may be future or present tense 8/30/2019

Outcomes (continued) Outcomes are a person’s priority wishes and preferences Outcomes increase the person’s satisfaction with their quality of life. An outcome describes a result-what the person wants or expects from supports they receive-what a person wants to do, be, achieve. An outcome may be specific or broad, short-term or long term, depending on the person, as long as it is measurable and reflects the person’s preferences. Outcomes justify why particular services/supports are included in the plan. An outcome tells the purpose of the service. 8/30/2019

Outcomes (continued) Focus on whether or not the identified statement is actually a personal outcome for the person. This means: Look for evidence that the person directed the outcome him/herself (even with needed assistance), Verify that it is actually an outcome statement and not a service statement, Ensure the outcome is supported by discovery information, and Verify that it is something that the person wants/desires for him/herself.  8/30/2019

Summary Overall improvements state- wide Increased consistency in PASRR Increased consistency on Outcomes State-wide training on Outcomes is a priority 8/30/2019

Contract Accountability & Oversight/IDD Services Thank you Contract Accountability & Oversight/IDD Services LocalAuthorityCAO@hhsc.state.tx.us 8/30/2019