Using CORE NDICATORS in Federal HCBS Reviews Jon Fortune, Ed.D David Heath, MPA Wyoming Developmental Disabilities Division & the Wyoming INstitute for Disabilities (WIND-UCE)

HCBS Quality Framework Protocol Red - Indicates that information gathered by Core Indicators provides data that can be reviewed by CMS DomainSub-Domain I. Participant AccessA. Information/referral B. Enrollment II. Participant-centeredA. Participant-centered service planning Service planning and B. Service Delivery Delivery III. Provider CapabilitiesA. Provider Networks & Availability B. Provider Qualifications C. Ongoing Monitoring

HCBS Protocol (cont.) DomainSub-Domain IV. Participant safeguardsA. Abuse, neglect, exploitation B. Major & unusual Incidents C. Housing & environment D. Behavior interventions E. Medication management F. Personal safety & security G. Natural disasters V. Participant rights &A. Grievances ResponsibilitiesB. Due process C. Fundamental Rights

HCBS Protocol (cont.) DomainSub-Domain VI. Participant outcomes &A. Participant satisfaction SatisfactionB. Participant outcomes VII.System performanceA. System performance appraisal B. Continuous quality improvement C. Cultural competency D. Participant & stakeholder involvement E. Financial integrity

Several other features in addition to 150 core indicators helped: Use CARF…The Rehabilitation Accreditation Commission’s national standards for 3 waivers Individual waiver budget technology (DOORS) with good system architecture * Extensive rules/training RN, CDDN consultation Published service provider site survey reports

‘02 & ‘03 Results – Wyoming (Consumer Survey) Wyoming’s performance was strong along four principal scales – community inclusion, support-related choices, personal choices, and service coordination

Satisfaction with Work/Day Program (Consumer Survey) % (n=264) -YES -94.2% (n=260) 5.7% (n=17) -In between- 4.3% (n=12) 5.0% (n=15) -NO- 1.4% (n=4)

Satisfaction with Residential (Consumer Survey) % (n=288) -YES- 89.7% (n=272) 3.4% (n=11) -In Between- 5.6% (n=17) 7.1% (n=23) -NO- 4.6% (n=14)

Case Management (Individually-Selected Service Coordination) (Consumer Survey) 94.7% know their case manager 93% say their case manager helps them get things that they need if they ask 89.6% say that their case manager asks them what they want

Case Management (Family Surveys) 80.9% (combined total) Satisfied With Services Provided by Case Manager 71.3% Adult/Family 89.1% Child/Family 89.1% Child/Family 78.2% Family/Guardian 78.2% Family/Guardian (Thanks Washington State and Lisa Weber!!!)

General Information 91.6% (n=372) get the services that they need (66% of those answering were consumers) 3.1% of agency boards are consumers 19.8% of boards are family members Community Inclusion is high 90%) Choice and decision making was high (most had input)

Range of annual per person expenditure by living arrangement (2002) MinimumMaximumAverageLiving Arrangement $1,800$187,270$31,6571With parents or relatives $32,700$73,447$58,7452Foster Home $1,800$109,187$21,0093Independent in own home or rental unit $1,800$135,760$36,3614Independent with regular home-based services or monitoring $21,528$185,432$59,8976Semi-independent unit with supervisory staff in bldg. $9,864$299,134$82,6487Group residence with staff providing care, supervision and training $26,500$173,130$75,5708Personal care facility with staff providing care, but no training or nursing services

Mortality, Serious Injury and Abuse/Neglect (2002) CMS reviewers liked: NCI definitions of abuse/neglect (and that information was broken down in respect to restraints, injuries, and “substantiation”) NCI breakdown of mortality (by age and total number in each population bracket) NCI breakdown and definition of crimes (forcible rape, aggravated assault, larceny theft)

Direct service staff members $5.66 Need $10.23 (Core Indicator: staff pay and turnover) Funded July 1, 2002 Wyoming Legislature Turnover rate: 50% HELP WANTED

Contact Information National Core Indicators Web Site Jon Fortune, Ed.D David Heath, MPA DDD Wyoming Web Site Wyoming Core Indicators Web Site