Federal Quality Assurance and Improvement Initiatives Mary Jean Duckett Centers for Medicare and Medicaid Services May 8, 2002

Duckett 2 Shifting Federal focus - Current n Prospective assurances of quality in waiver applications followed by retrospective review, 3-5 years later n Quality assurance expectations to meet regulatory compliance and/or problem identification, most often with respect to health and welfare

Duckett 3 Shifting Federal focus - future n CMS recognizes that it has a role that goes beyond simply giving permission to states to develop institutional alternatives and to monitor compliance with regulatory requirements n It requires that it assess more closely the systems of quality assurance and improvement in place and that it provide direct assistance to its state partners concurrently

Duckett 4 CMSO Quality Initiatives  Establishing a Framework for Quality Improvement within HCBS  Developing Quality Improvement Tools for States  Developing Quality Improvement Tools for CMS  Engaging in Quality Assessment and Performance Improvement  Providing Technical Assistance and Resources

Duckett 5 CMSO

Duckett 6 Framework for Quality n National Inventory of Quality Improvement Strategies (DEHPG)  Establish a framework/description of relevant quality domains that will facilitate a common dialog  Identify relevant strategies which states might use to monitor and improve quality within those domains  Conduct research to establish the current “state of the art” for state QA/QI systems for information sharing and planning purposes

Duckett 7 Tools for States n Consumer Experience Survey/Users Guide (FSQG)  Voluntary Tool for States  2 Modules: Elderly/Non-elderly disabled and MR/DD

Duckett 8 Tools for States n Reliability and Validity of Consumer Experience Survey (FSQG)  Current status: Conducting field tests in 3 States  Expected Completion Date: October 2002

Duckett 9 Tools for States n Self Directed Measures (DEHPG)  Development of performance indicators aimed at family and self-directed service systems, i.e., system performance indicators  Serve as a guide to states as they develop their family and self-directed waivers  States could use it to assess the quality and comprehensiveness of their family and self- directed programs

Duckett 10 Tools for CMS n Collection and Analysis of State Data for Long-Term Care/ State Planning Data for Systems Change (DEHPG)  Develop a HCBS waiver database  Identify LTC data available and needed for planning  Design Data Reports and analytical tools  Develop data collection and transfer processes and procedures

Duckett 11 Quality Assessment and Improvement n HCBS Waiver Quality Review Protocol n Guide for Conducting Quality Reviews (FSQG)  Guide for States/Regional Offices (RO) to use as they conduct Quality Reviews  Focus on adequacy and appropriateness  Estimated Completion Date: October 2002

Duckett 12 National Contractor for HCBS Quality (DEHPG)  Resource to CMS Regional Offices (RO) and States  Follow up to RO visits utilizing the protocol where significant opportunities for improvement are identified  Urgent or Emergent follow-up in special circumstances  State requests for consultation, triaged through RO/CO

Duckett 13 National Contractor for HCBS Quality (DEHPG)  Contractors to assist in Root Cause Analysis and identification of quality improvement strategies  NOT look-behind review  NOT additional monitoring or review  Repository of CMS Quality related tools, Technical Assistance and Training  2002 focus for MR/DD

Duckett 14 Technical Assistance and Resources n Promising Practices (DEHPG)  3 year ongoing project to identify and describe promising practices within state programs intended to assist persons with disabilities of all ages to live and fully participate in communities of their choice  Highlighted will be both broad systems reform efforts (e.g., Michigan’s 1915b/c combo for specialty services) as well as specific tools utilized by states (e.g., Wyoming’s method for individual budgets)  Ongoing posting to CMS web site.

Duckett 15 Technical Assistance and Resources n Promising Practices n n Look for “promising practices in home and community-based services”

Duckett 16 TA (cont.) n Data Readiness Project (FSQG)  Compile info on selected QI activities that are data driven  Prepare technical assistance briefs to states  Estimated completion date: late spring  Provide technical assistance to selected states  Estimated completion date: October 2002

Duckett 17 TA (cont.) n Conference on Quality Measurement and Improvement  May 2-3, 2002, Nashville, TN  Feature national/state experts and best practices in quality measurement/improvement  Will include practices identified through the “Data Readiness” project

Duckett 18 Other Initiatives of Note n Study of the impact of Medicaid home and community based service programs on quality of life, quality of care, utilization and cost (OSP - Lewin) –Elderly/Disabled and Persons with MR/DD –Resource Network -

Duckett 19 Other Initiatives of Note n Development and Validation of Performance Measure Set for for the Evaluation of Medicaid Services Rendered to People with DD (SCG) –Indicators for ICF/MR settings –Compliance/Feedback/Benchmarking

Duckett 20 Summary n Coordinated, quality effort that utilizes prospective assurances and retrospective reviews, but will include concurrent quality improvements to further enable the full inclusion and participation of persons with disabilities in communities of their choice.