Monitoring and Oversight Division of Developmental Services Department of Behavioral Health and Developmental Services 2013 Provider Training Module 15.

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Presentation transcript:

Monitoring and Oversight Division of Developmental Services Department of Behavioral Health and Developmental Services 2013 Provider Training Module 15

ID Waiver Provider Modules 1 = Overview of the ID and DS Waivers 2 = Becoming a n ID Waiver Provider 3 = Supporting People in the ID and DS Waivers 4 = Introduction to Planning 5 = Residential Services 6 = PA, Respite and Companion (Agency-Directed) 7 = Employment and other Day Services 8= Crisis Stabilization – ID Waver 9= Assistive Technology, Environmental Modifications and Transition Services 10 = Skilled Nursing 11= Personal Emergency Response System 12 = Consumer Directed Services and Services Facilitation 13 = Therapeutic Consultation 14 = Preauthorization and Billing 15 = Monitoring and Oversight 2

3 SC = Support Coordinator CSB = Community Services Board DBHDS = Department of Behavioral Health and Developmental Services DDS = Division of Development Services OL= Office of Licensing OHR = Office of Human Rights DOJ = U.S. Department of Justice DMAS = Department of Medical Assistance Services QMR = DMAS Quality Management Review Common Acronyms

4 The Support Coordinator Licensing Human Rights The DOJ Settlement Agreement DMAS This module covers monitoring and oversight activities of... Monitoring and Oversight

5 Support Coordinators

6 Support Coordinators play a critical role in assuring safety. They are responsible for assessing, inking, coordinating and monitoring the service and support needs of individuals.

7 Support Coordinators What are SCs looking for? A safe environment Unidentified risks or needs Appropriate services and supports Services delivered as per ISP/PFS

8 Support Coordinators What are SCs looking for? Person-centered review from providers within 10 calendar days following the due date

9 Key Agencies involved in Monitoring and Oversight

10 DBHDS: Office of Licensing

11 Licensing Specialists Employed by DBHDS Issues DBHDS licenses Reviews and inspects provider locations Reviews provider documentation Investigates complaints Provides technical assistance on regulations

12 DBHDS: Office of Licensing What are OL Specialists looking for? Provider following Licensing Regulations A clean and safe environment Accurate documentation Services delivered as per ISP/PFS

13 DBHDS: Office of Human Rights

14 Human Rights Advocates Advocate for individuals Investigate human rights complaints Provide consultation and education Provide technical assistance and support Local Human Rights Committees Employed by DBHDS

15 What are OHR Advocates looking for? Provider following HR regulations People being treated with dignity and respect Freedom from abuse or exploitation Individual participation in decision making Human Rights Advocates

16 DOJ Settlement Agreement

17 DOJ Settlement Agreement The DOJ settlement agreement does the following: Guides moves to most integrated settings Expands role of the DBHDS Strengthens quality and risk management how

18 DOJ Settlement Agreement Post-Move Monitoring

19 DOJ Settlement Agreement Post-Move Monitoring for individuals leaving training centers ensures that… essential supports are in place individuals are successful in their new home providers are trained and supported

20 DOJ Settlement Agreement Post-Move Monitoring for individuals moving from Training Centers includes: meeting with the individual and provider confirmation of essential supports plan for any needed follow-up

21 DOJ Settlement Agreement Post Move Monitoring is conducted by: Training Center Office of Licensing Office of Human Rights CSB (Community Service Boards)

22 DOJ Settlement Agreement ~3 day ~7 day ~10 day ~17 day ~1 mo ~2 mo ~3 mo ~4 mo ~5 mo ~6 mo ~7 mo ~8 mo ~9 mo ~10 mo ~11 mo ~12 mo TCxxx OLSxxxxxxxxxxxxxx CSBxxxxxxxxxxxxx OHRX Additional visits may occur based on needs of individual or provider

23 DOJ Settlement Agreement The SA also defines a new level of support coordination: Enhanced

24 DOJ Settlement Agreement Enhanced level provides in person visit in the home every other month.

25 DOJ Settlement Agreement Enhanced level provides in person visit every 30 days when: Providers have conditional/provisional licenses Medical and behavioral need are high Service interruptions exceed 30 days Crises are a concern Individuals live in settings of 5 or more Moved from a training center < 12 months

26 DMAS Quality Management Reviews

27 DMAS QMR Employed by DMAS Provides technical assistance related to federal assurances Reviews documentation for accuracy Provides feedback to improve provider services and documentation

28 DMAS QMR Dates and times of service Amount and type of activities provided The individual’s response to settings and supports Services delivered as per ISP/PFS What QMR is looking for?

29