Office of Long Term Living Quality Management, Metrics & Analytics

Agenda Metrics & Analytics Assurances: Qualified Providers LOC Assurances Service Plans Health & Welfare Financial Administrative QIS Metrics & Analytics Burd & DeSantis Assurances: Qualified Providers-Diane LOC Assurances-Carol Service Plans-Melanie Health & Welfare-Melanie Financial-Melanie Administrative-Melanie QIS-Melanie Choice and ODCDS-McNamara

Metrics and Analytics Division Mission and Functions

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.

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

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

Division Functions (cont’d) 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

Management Reports 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

Quality Management, Metrics and Analytics Data Collection and Reporting Section

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

SAMS/OMNIA 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.

The OLTL Network Assessors Care Managers/Service Coordinators Protective Service Workers SAMS Administrators Network Supervisors Network Administrators Over and Under 60 NHT Transition Coordinators

Resources Provided to the Network Webinars Training Manuals Videos Dashboards Ad Hoc Requests

Where the Resource Material is Located Unsecured FTP Site for access by the AAA Network Allshare Drive (S:) Drive for access by PDA and OLTL staff OLTL Website

Qualified Providers Assurance QMET Update Current Monitoring Status & Waiver Standards Review

Current Monitoring Status The QMET has completed all monitoring visits of HCBS providers to date (328). In addition to waiver provider visits QMET has completed: 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

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 QMET is only reviewing Waiver programs for standards that are listed in the waiver for the services the provider actually provide to consumers The FEA standards finalized on 12/17/08. Available on QMET website.

Where are the QMETs finding? Overall compliance with the waiver program standards is excellent. Most commonly missed standards are Distributing hotline number to consumers Incident reporting was inconsistent with waiver requirements Billing/ Bookkeeping Errors Documentation

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 Now that the QMET has had the opportunity to work with the tool in the field, we want to rephrase some of the questions so they are more logical and more precise. We also recognize the information requested in the initial letter was not as precise as it could be. We are working to make ourselves clearer. (The lists we request of providers were not worded in a way that we were getting the information that we wanted, so we are trying to get the language right. Currently, when the information is not what we need, we call providers and work out the details so we get what we need). Any changes will Providers will continue to receive a 30 day notice prior to our visit. A thanks to all providers for working so closely with us as we ask for information prior to our arrival. By providing timely and accurate information, our visits have been smooth and efficient. QMET recognizes that AAAs and under 60 providers need more clarification on what is expected of them in regards to agencies they subcontract with. We are working on information and training materials for AAAs and under 60 providers that clearly explain the waiver requirements as to what subcontractors need to meet and who is monitoring those subcontractors to ensure they meet CMS expectations as waiver providers.

QMET Resources The Waiver Reference Guide and FEA standards can be found at http://www.dpw.state.pa.us/PartnersProviders/PMQ/QMMA/QMET/QMETResources/ Or Type “QMET Resources” into your favorite search engine QMET protocols also found on website.

Level of Care Assurance

Level of Care 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: The level of care performance measure reports have been run and the data aggregated over the first 6 months of the calendar year. We have also begun to obtain our first round of non-compliance details information for review.

Level of Care Next Steps The performance measure for sub-assurance 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.

What Does this Mean to You? As a participant, advocate or stakeholder As a Provider of enrollment, level of care assessment or supports coordination/care management OLTL The changes in the performance measures and timing should not have any impact on consumers. The changes mean that providers will no longer be sent or required to complete a Standards Implementation Plan for each month that you receive a non-compliance notice per report Monitoring activities by the QMET’s will include information provided on the individual providers performance with the level of care sub-assurances. Bureau of Individual Supports will be provided information on non-compliance

Service Plan Assurance

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. Through the recent Aging and Attendant Care Waiver renewals and work plans, the Service Assurance has many enhancements planned to standardize the way service plans are developed and reviewed. When the work plan steps are completed, the data needed for the service plan performance measures regarding service plan development and review can be obtained.

What does this mean to you?…. Service Plans Providers and OLTL staff can expect training on new forms and processes for service plans to be on going as needed Participants can expect consistent forms and processes will be used across the state OLtL staff

Satisfaction Surveys One Survey for all Waivers Reduce Mailings and Participant Intrusion Gather Similar Facts on each Waiver

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

Mailings will be every 4 months 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

Participant Satisfaction Surveys New questions will be added to surveys for Health and Welfare Assurance as needed to gather appropriate information. Such as: “I know how to report abuse, neglect, or exploitation including the use of restraints and other restrictions.” Possible answers are Yes, No, I don’t understand, & N/A

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 Refer questions to Helpline (1-800-757-5042) Participants may receive a survey in the mail Complete survey & return in postage paid envelope Contact Helpline if have questions (1-800-757-5042) OLtL staff

Health & Welfare Assurance

Health & Welfare Assurance Update Operational Functions Incident Data for All Waivers available for OLTL use Quality Assurance Helpline Quality Assurance Helpline Database Clarification and revision of Performance Measures Can Track and trend aggregated data for Incidents (Aging only) & Complaints Helpline – Intake for complaints Rewording of PMs and elimination of one PM

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 Participants are encouraged to work with their provider and or service coordinator - First level of complaints should be addressed with provider and Service Coordinator. If not able to resolve then call the helpline.

What does this mean to you?.... 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 Complaints & Incidents

Financial Accountability Assurance

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 The Bureau of Provider Support is processing a paid claim review report, which compares paid claim against allowable procedure codes. The report is analyzed and sent to QMU for our PM tracking and trending.

Financial Accountability Assurance 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).

What does this mean for you?…. Provider, OLTL BPS staff and BFO staff notified if billing errors discovered through financial report or QMET review Correction(s) initiated for identified issues and to prevent reoccurence Participants responsible for correct authorization of time sheets

Administrative Authority Assurance

Administrative Authority Assurance As reported by the QMEU 30 Policies or Directives have been initiated since 01/01/2009, including: 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) First bullet refers to - One of the PMs for AA refers to the QMET monitoring which you heard about previously Provider rates policy is one policy with various #s

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.

Quality Improvement Strategy

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 QMU will continue to monitor some performance measures after they are replaced QMU beginning to go beyond the CMS mandated assurances to monitor other quality focus areas such as access, participant rights and responsibilities, etc. When some PMs appear to lose relevance – i.e. no problems or issues are ever found – they may be replaced but will still be monitored

QIS Enhancements QIS expected to change Changes to quality sections of approved 1915(c) waiver applications Listed on annual CMS 372 reports Deletion of 2 performance measures AA – % new policy monitored and remediated by non state entities HW – # providers who fail to report incidents CMS expects quality improvement strategies to change – it is part of the nature of the strategy that you continually review and assess the efficiency and quality (are you getting the results you want?) and make changes for improvement. OLTL has changed many of the performance measures that were approved in the recent Aging and ACW renewals.

OLTL Quality Council First meeting was an orientation meeting held in June 2009 First official meeting was held in August 2009 Comprised of Participants, Participants Family Members, Provider Agencies, AAA’s, Aging Community Representatives, OLTL Staff

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.

What does this mean for you?….. 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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