1. MFP Quality Requirements
August 15, 2012

2. NQE Consortium Members:
Agenda
Review the elements and monitoring processes for each of the MFP quality requirements
Review data needed to complete the MFP Semi-Annual Report
State perspectives from MFP colleagues
Discussion and questions
NQE Consortium Members:
Truven Health Analytics
Human Services
Research Institute
Boston College National Resource Center for Participant-Directed Services
National Quality Enterprise - Grant Funded by CMS

3. MFP Quality Requirements
Quality Improvement Strategy - Consistent with the 1915(c) quality requirements
Critical Incident Reporting and Management System*
24-Hour Backup Strategy*
Risk Assessment and Mitigation Protocol*
*Monitoring process to ensure that systems/protocols are working as planned
National Quality Enterprise - Grant Funded by CMS

4. MFP Quality Requirements
Quality Improvement Strategy
Critical Incident Reporting and Management
24-hr Backup Strategy
Risk Assessment and Mitigation
MFP Participant
National Quality Enterprise - Grant Funded by CMS

5. Why Additional MFP Quality Requirements?
Vulnerable population
Dependence on institutionally-based care
Potentially little connection to the community
Transitioning presents unique challenges
Variety of populations with a variety of needs
Wide variety of available housing and community supports
National Quality Enterprise - Grant Funded by CMS

6. 1915(c) Quality Improvement Strategy
QIS must meet 1915c quality requirements
1915c HCBS waiver application
Applies to all programs and services serving MFP participants including:
HCBS services
Demonstration services
Supplemental services
State Plan services
National Quality Enterprise - Grant Funded by CMS

7. 1915(c) QIS – Required Elements
Performance measures
Demonstrate whether the state is meeting the assurances
Remediation strategies
Take actions to fix or address non-compliance
Trending and Analysis
Identify trends and areas in need of improvement
Quality Improvement Initiatives
Carry out quality improvement initiatives/projects
Evaluate their effectiveness
National Quality Enterprise - Grant Funded by CMS

8. Risk Assessment and Mitigation
Written plan for each MFP participant that:
Identifies risks in transitioning to the community, and
Outlines how these risks will be/are being addressed/mitigated
National Quality Enterprise - Grant Funded by CMS

9. Risk Assessment and Mitigation
Define potential risks
Health risks
Behavioral/mental health risks
Stability of the informal caregiver system
Address the identified risk in the comprehensive service plan
National Quality Enterprise - Grant Funded by CMS

10. Risk Assessment and Mitigation - Monitoring Process
How will you know that this process is working as planned?
Are risk assessments being conducted?
Are risk plans adequate and appropriate?
Are risk plans implemented and monitored by the case managers and transition coordinators (if appropriate)?
Are risk plans revised as risks change?
Who will take action if remediation is needed?
National Quality Enterprise - Grant Funded by CMS

11. National Quality Enterprise - Grant Funded by CMS
24-Hour Backup
Each MFP participant must have an individualized backup plan in place to respond to and address:
Any lapse in essential services, and
Other circumstances that could have a negative effect on a participant’s health or welfare.
National Quality Enterprise - Grant Funded by CMS

12. Elements of a 24-Hour Backup Strategy
Individual backup plan mechanisms may include:
Provider(s) that agree to respond 24/7
Informal supports available to respond 24/7
Access to live person 24/7 (e.g. on call case manager)
Other agreed-upon resources
Plans may vary for different populations, service delivery systems, models or geographic locations
National Quality Enterprise - Grant Funded by CMS

13. 24-Hour Backup – Monitoring Process
How will you know that the process is working as planned?
Do all MFP participants have a 24/7 backup plan?
Are these plans adequate and appropriate?
Are plans revised as needed?
Who will take action if remediation is needed?
National Quality Enterprise - Grant Funded by CMS

14. Critical Incidents and Reporting System (CIRS)
System to report incidents on MFP participants and track resolution
If MFP will be included in state’s current CIRS, it must be able to separately track and report on MFP participants
Major components states must describe in their Operational Protocol:
Reporting requirements (e.g., types of incidents, reporting authority, required reporters, reporting timeframes)
Training/education to participants and others (as appropriate) on abuse, neglect and exploitation reporting
Responsible entity and process for reviewing (e.g., investigation) critical incidents
State agency/process for incident management system oversight
National Quality Enterprise - Grant Funded by CMS

15. CIRS–Required Elements
How will the state know that CIRS processes are working as intended?
Which state agency (or agencies) will be responsible for overseeing the reporting of and response to critical incidents?
Who will review critical incidents and act upon them in the event that remediation/improvement is needed?
Will the monitoring approach differ across populations?
National Quality Enterprise - Grant Funded by CMS

16. National Quality Enterprise - Grant Funded by CMS
System Improvement
For all 3 Additional Quality Requirements:
Critical Incident Reporting and Management System
24-Hour Backup Strategy
Risk Assessment and Mitigation Protocol
System Improvement
Identify trends and areas in need of improvement
Carry out quality improvement initiatives/projects
Evaluate effectiveness of initiatives/projects
National Quality Enterprise - Grant Funded by CMS

17. MFP Semi-Annual Report
Quality section of the MFP Semi-Annual Report to CMS includes:
Improvements and Challenges
Use and responsiveness of the 24-hour backup system
Findings of critical incidents reports
National Quality Enterprise - Grant Funded by CMS

18. MFP Semi-Annual Report - QIS
Notable improvements with the HCBS quality management system
Significant challenges related to:
Discovery
Remediation
Improvement
National Quality Enterprise - Grant Funded by CMS

19. MFP Semi-Annual Report – 24-Hour Backup
Use and responsiveness of the 24-hour backup
By population
Elderly; MR/DD; MI; PD; IMD/Chronic Hospital
By type of assistance needed
Transportation to medical appointment
Life support equipment repair/replacement
Critical Health Services
Direct service/support workers not showing up
Other
National Quality Enterprise - Grant Funded by CMS

20. MFP Semi-Annual Report - CIRS
Findings of critical incidents reports
Abuse , Neglect, Exploitation
Hospitalizations, Emergency Room Visits
How many occurred within 30 days of discharge from a hospital or other institutional setting?
Deaths due to abuse, neglect, or exploitation
Death due to breakdown in the 24-hour backup system
Involvement with the criminal justice system
Medication Errors
Other
National Quality Enterprise - Grant Funded by CMS

21. MFP Semi-Annual Report - CIRS
What was the result of investigation(s) of incident(s)?
Did the state make changes, either for the consumer(s) or its system, as a result of the analysis of critical incidents?
National Quality Enterprise - Grant Funded by CMS

22. National Quality Enterprise - Grant Funded by CMS
State Perspectives
Jake Reuter, North Dakota MFP Project Director
Risk Assessment and Mitigation Process
Darrell Curtis, MFP Project Director (Louisiana)
Critical Incident Reporting and Management
National Quality Enterprise - Grant Funded by CMS

23. National Quality Enterprise - Grant Funded by CMS
State Resources
North Dakota’s Money Follows the Person Project
Louisiana’s Money Follows the Person Project
National Quality Enterprise - Grant Funded by CMS

24. Questions? The National HCBS Quality Enterprise Website
National Quality Enterprise - Grant Funded by CMS