Partners for Children Quality Improvement Health & Welfare Jill Abramson, MD MPH February15, Training

PFC Provider Training   Overview   Care Coordination/CCSNL/Communication   Family-Centered Action Plan   Services/Billing   Quality Improvement / Health & Welfare

PFC Quality Improvement   PFC QI has these components: – –CMS Assurances – –Remediation – –Monitoring (QI reports from agencies) – –Quality Improvement Strategy

PFC - CMS Improvement .  Assurances to Centers of Medicare and Medicaid Services that State will provide oversight of the federal waiver program.

PFC - Assurances   Areas: – –Level of Care – –Service Plan – –Qualified Providers – –Health and Welfare – –Administrative Authority – –Financial Accountability

PFC - Assurances   Enrollment/Level of Care – –Freedom of Choice – –Medical eligibility/Level of care   criteria met   expected 30 days inpatient per year if not for PFC waiver [or diligence of family] – –LOC form completed at enrollment and annually

PFC - Assurances   Service Plan (in F-CAP) – –Service Plans address Needs including Health/Safety risk factors, and Goals – –Service plans updated at specified intervals – –Services delivered according to plan

PFC Assurances   Qualified Providers – –Providers meet and adhere to standards   Current license, registration   Administrative Authority ( Medi-Cal exercises oversight of waiver functions performed by other agencies )   Health and Welfare – that the client is safely living in the home with no abuse, neglect, exploitation   Financial Accountability

PFC Assurances   Participating counties are considered ‘sub-state agencies’ and assist with data entry for assurances.

Questions?

PFC HEALTH AND WELFARE STANDARDS

Health & Welfare Assurance   The State assures that the client is safely living in the home with no:   abuse,   neglect,   exploitation.

Health and Welfare Training and Education   CCSNL & Care Coordinator are responsible for child and family training and education.

Health and Welfare Training and Education cont.   CCSNL discusses and provides the waiver enrollment/information packet which contains: – –Description of different types of abuse, neglect, exploitation; – –How to recognize if any of these occur; and whom to contact to report such events/incidents; – –The Care Coordinator will provide additional training as necessary.

Care Coordinator Risk Assessment Coordinator’s risk assessment will address: Environmental safety Medical fragility Psychosocial factors Note: Upon waiver enrollment, ongoing risk assessments will be a part of the Care Coordinator’s responsibility

Environmental Risk Assessment   Assurance that the area where the child will be cared for can accommodate the use, maintenance, and cleaning of all medical devices, equipment, and storage supplies necessary to maintain the child in the home in comfort and safety, and to facilitate the care required.

Environmental Risk Assessment (cont.) .  Assurance that primary and back-up public utility, communication, and fire safety systems and devices are available, installed, and in working order, including grounded electrical outlets, smoke detectors, fire extinguishers, carbon monoxide detectors and telephone services.

Environmental Risk Assessment (cont.)   Evidence that local emergency and rescue services and public utility services have been notified that a person with special needs resides in the home.

Environmental Risk Assessment (cont.)   Documentation that the caregivers have been trained to support the care needs of the child.   Evaluation for risk of abuse, neglect and exploitation.

Psychosocial Risk Factors Risk for anticipatory grief   Isolation from peers   Depression   Parental distress and burnout The findings must be documented in the F-CAP.

Mitigation of Environmental Risks   Families with environmental risk factors identified during the assessment will be referred to appropriate agencies or community resources.   In case of abuse, neglect or exploitation an incident report must be filed.

Where To Report? Where To Report? In California, all individuals providing or monitoring health care are considered mandated reporters. Child abuse – –County Welfare Department (CPS) – –Probation Department (if designated by the county to receive mandated reports) – –Police or Sheriff’s Department – –Licensing and Certification (L&C) who receives, responds to, and investigates complaints of suspected, alleged, and reported abuse in licensed health-care facilities

Where To Report? Dependent adult abuse – –County Adult Protective Services (APS) – –Local law enforcement agency.

If the Care Coordinator Receives Initial Complaint Fill out Event Reporting Form Report to CPS/APS as required by law Report to CCSNL Follow up with Family Document in child’s case file

If the PFC/Waiver Service Provider Receives Initial Complaint   Report to CPS/APS as required by law   Tell CC, who reports to CCSNL

Responsibility for Oversight of Critical Incidents and Events   In the event of involvement of the Child/Adult Health and Welfare system, the CCSNL and Care Coordinator will:   monitor the child’s health and safety to ensure the issues have been resolved.

Responsibility for Oversight of Critical Incidents and Events   The State Systems of Care Division will partner with L&C in the oversight of reporting and responding to critical incidents or events.

Remediation/Fixing Individual Problems The CCSNL will begin the remediation process   Within 2-5 working days (or sooner, To the extent mandated by California law)   After discovery of non-compliance, and,

Remediation/Fixing Individual Problems – –F-CAP does not meet requirements for continuous monitoring of environmental assessments, family social evaluations or information regarding abuse, neglect and exploitation – –Inappropriate or untimely action occurs in response to a report (abuse, neglect, exploitation, critical incident or event, etc.) The CCSNL will begin the remediation process as it relates to health and welfare sub- assurances, such as:

Remediation (cont.)   L&C will provide a Complaint Line Notice and a contact number for use by all participating providers and the public.   At the time of waiver enrollment, all staff, HHA/HAs and participants will receive instructions that any critical event, incident or complaint may be reported to the CCSNL, Care Coordinator and/or directly to the staff at L&C.

Remediation (cont.)   The CCSNL or Care Coordinator will also use the Event Reporting form to document and report concerns, problems, and incidents to ensure timely investigation and resolution.

The Event Reporting Form is Designed to Document The agency and name of the individual completing the report, if applicable The name and CCS number of the participant The telephone number of the participant and/or parent/legal guardian A description of the event or incident (the who, what, when and where)

The Event Reporting Form is Designed to Document Who reported the event or incident The state and local agencies, the treating physician, and law enforcement who were notified, and when The plan of action to address/resolve the event or incident (who, what, when) The resolution and date resolved.

More on Reporting   The CC will documentation any reported incident in the child’s file. If it is determined that reporting has not been completed according to statutory requirements, an Event Reporting form must be completed and forwarded to the appropriate agency.   The CCSNL will update the child’s case file to document L&C’s actions and recommendations and the event/incident resolution. During the L&C investigation, the participant will continue to receive necessary services.

PFC Quality Improvement   Monitoring (QI reports from agencies) – –Annual Reports – –Continuous monitoring of identified areas   Quality Improvement Strategy

PFC Provider Training   Overview   Care Coordination/CCSNL/Communication   Family-Centered Action Plan   Services/Billing   Quality Improvement/ Health & Welfare

Questions?