Quality Improvement Strategy
Context for the Focus on Quality Began with the growth & expansion of HCBS waiver programs Growth in expenditures Growth in people served Growth in consumer direction Self Direction presents challenges for assuring quality
CMS approach to Quality A quality management data driven model with continuous over-sight Quality elements are designed into the program Each state has a quality strategy to continually evaluate it’s own performance, to correct deficiencies and make system improvements….which will tell us if assurances are met outcomes are achieved people are satisfied CMS reviews the effectiveness of the state’s Quality Management Strategy
CMS Quality Framework
Quality Framework Focus Areas Participant Access Information and referral; intake and eligibility determination; referral; choice Participant Service Planning Assessment; service plan, implementation & monitoring; respond to changing needs; choice; participant direction Provider Capacity Licensure and certification; training; provider monitoring Participant Safeguards Incident management; risk assessment; behavior management; med administration; natural disasters Rights and Responsibilities Due process; grievance procedures Outcomes and Satisfaction System Performance Quality Improvement program; financial management
Quality Framework Processes Design… build quality in up front Discovery… look for problems & opportunities for improvement Remediation… fix problems Improvement… make improvements
Community First Choice Establish & maintain a quality assurance system Incorporate feedback Monitor the health and well-being of each individual Provide information about the provisions of quality assurance Requirements of CFCO regulations
Community First Choice CMS Quality Framework Build upon existing structure Develop Quality Outcomes Consumer Satisfaction