1. Contract Accountability & Oversight
Quality Assurance Authority Reviews

2. FY 2018 Trends Quality Assurance Texas Home Living
Home & Community-based Services
PASRR
8/30/2019

3. Quality Assurance State-Wide Averages
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4. Quality Assurance State-Wide Trends
Includes Performance Contract, General Revenue and Community First Choice
All Review Sections were above 90% except for 2
Data-79.37%
Additional Items of No-Compliance %
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5. Quality Assurance Data-79.37%
11 LIDDAs-R0NR and R0NF assignment inaccuracies in CARE
2 LIDDAs-Critical Incidents and/or CANRS Reporting
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6. Quality Assurance Additional Items-43.75% 8 LIDDAs-PHI Violations
2 LIDDAs-Reporting allegations of A/N
1 LIDDA-Managing a Transfer/Concern Resolution
1 LIDDA-Rights Restriction
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7. TxHmL State-Wide Averages
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8. TxHmL State-Wide Trends
All but 2 Elements were above 90%
Service Coordinator Assurances-86.39%-38 LIDDAs had findings in this area
Guardianship-86.0%-8 LIDDAs had findings in this area
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9. Most Common Findings in TxHmL
Service Coordinator Assurances
Discovery & Person Directed Planning
Developing & Implementing PDP
IPC Development
Monitoring Services
Reporting Progress Toward Outcomes
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10. Service Coordination Assurances
Discovery & Person Directed Planning
Only 2 LIDDAs had findings in this area
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11. Service Coordination Assurances
Developing & Implementing a PDP-38 LIDDAs
Outcomes are service statements-30 LIDDAs
Outcomes are not developed-5 LIDDAs
Services are not included-16 LIDDAs
Outcomes are not supported by discovery-23 LIDDAs
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12. Service Coordination Assurances
IPC Development
8 LIDDAs had findings in this area
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13. Service Coordination Assurances
Monitoring Services
Monitoring delivery & satisfaction with services-37 LIDDAs
Making face-to-face contact-16 LIDDAs
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14. Service Coordination Assurances
Reporting Progress Toward Outcomes
37 LIDDAs had findings in this area
8/30/2019

15. HCS State-Wide Averages
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16. HCS State-Wide Trends All but 3 Elements were above 90%
Person/Family Directed Planning-87.08%-32 LIDDAs had findings in this area
Service Coordination Monitoring-79.60%-39 LIDDAs had findings in this area
Program Specific Training-89.47%-2 LIDDAs had findings in this area
8/30/2019

17. Most Common Findings in HCS
Person/Family Directed Planning
Outcomes are Service Statements-29 LIDDAs
Outcomes are not supported by discovery/not person-centered-32 LIDDAs
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18. Most Common Findings in HCS
Service Coordination Monitoring
Monitoring delivery of and satisfaction with services-39 LIDDAs
Face-to-face Contact-8 LIDDAs
Reporting Progress Toward Outcomes- 39 LIDDAs
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19. PASRR State-Wide Averages
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20. PASRR State-Wide Averages (continued)
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21. PASRR State-Wide Trends
Top 10 Findings Based on Average Scores Across all LIDDAs
Top 5 Findings Based on Number of LIDDAs with Findings
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22. Top 10 Findings in PASRR Based on Average Scores
And Based on Number of LIDDAs with Findings
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23. #10 Pre-Move Site Review - 17.503 (d) (Ave score of 80.30%)
# LIDDAs
Finding 11
No evidence Service Coordinator conducted Pre-Move Site Review before individual transitioned from Nursing Facility to community 3
No evidence Service Coordinator reviewed Essential Supports listed on Diversion plan in Pre-move Site Review
8/30/2019

24. #9 Post-Move Monitoring – 17.503(f) (Ave score of 80.14%)
# LIDDAs
Finding 15
No evidence first, second, or third post move monitoring visits were completed within the required timeframe 13
No evidence Service Coordinator addressed essential supports, identified gaps in care, or addressed gaps to reduce potential risks during first, second, or third post-move monitoring visits
8/30/2019

25. #8 Coordination with Nursing Care Plan – 17. 502(7) (Ave score of 79
# LIDDAs
Finding 17
No evidence information in Nursing Facility Care Plan was coordinated with ISP
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26. #7 Comprehensive Care Plan – 17.501 (b) (2) (D) (Ave score of 74.85%)
# LIDDAs
Finding 18
Outcomes for Specialized Therapies in the ISP were different than the outcomes in the NF Therapy Plans 9
No copy of Care Plan in record and no documented efforts to obtain the Care Plan 6
NF Plan of Care in the record not the most current Plan of Care 3
Most current NF Care Plan was not in record until week of CAO Review.
8/30/2019

27. #6 Community Living Options – 17.501 (b)(2)(A) Ave score of 73.94%)
#LIDDAs
Finding 29
No evidence CLO was provided within the required timeframe 6
No evidence CLO was presented to the individual 4
No evidence community living options were provided when conducting the PE for persons diverting from nursing facility
No evidence CLO was presented at least annually to persons refusing service coordination 3
No evidence CLO was provided at the Service Coordinator's first face-to-face contact
8/30/2019

28. #5 Coordination and Monitoring of Services – 17
#5 Coordination and Monitoring of Services – (3) (Ave score of 67.15%)
#LIDDAs
Finding 33
No evidence of reporting progress/lack of progress towards outcomes during the quarters of the ISP 18
No evidence delivery of or satisfaction with services was monitored with individual/LAR during quarter of ISP 17
No documented attempts to coordinate PASRR Specialized Services or to obtain outcomes for services from NF staff 4
No evidence of frequency, amount, or duration of the specialized services 2
No evidence that Form 1016 SPT PASRR Specialized Services Discussion Checklist was completed in conjunction with SPT meeting.
8/30/2019

29. #4 Guardianship – (Ave score of 62.65%)
#LIDDAs
Finding 5
No evidence of current letter of guardianship in record or of request for updated copy 9
No evidence of SPT discussion regarding possible guardianship referrals when needed
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30. #3 Transition Planning – 17.503 (a) (Ave score of 54.35%)
#LIDDAs
Finding 8
No evidence Service Coordinator completed transition plan as required 2
No evidence Service Coordinator addressed concerns about community living
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31. #2 Coordination of Specialized Services – 17
#2 Coordination of Specialized Services – (b)(2)(B) (Ave score of 53.16%)
#LIDDAs
Finding 23
No evidence of PASRR Specialized Services Form being completed 14
PSS forms for the SPTs did not reflect information in ISPs 12
No evidence PASRR Specialized Services Form was entered into TMHP timely for SPT meeting 2
LIDDA specialized service was agreed upon by SPT and added to initial PSS form, but referral for specialized services was not initiated-no evidence Service Coordinator facilitated coordination of this service in a timely manner
No evidence CLO Form 1039 was completed when CLO was presented
8/30/2019

32. #1 ISP Revisions – 17.501 (b)(1)(D) (Ave score of 50.48%)
#LIDDAs
Finding 26
Specialized services not added to ISP/ISP not updated 3
No discussion of PASRR Specialized Services
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33. Top 5 Findings in PASRR Based on Number of LIDDAs with Findings
How many LIDDAs had one or more findings for each element?
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34. #5 Individual Service Plan
(2)(c) Identifying Specialized Services –
28 of 39 LIDDAs had one or more findings
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35. #4 Attachment A-4 Nursing Facility Transitions
(b)(2)(B) Coordination of Specialized Services –
31 of 39 LIDDAs had one or more findings
*This was #2 for average scores
(b)(2) (A) Community Living Options –
30 of 39 LIDDAs had one or more findings
*This was #6 for average scores
(b)(1)(D) Revision of ISP –
29 of 39 LIDDAs had one or more findings
*This was #1 for average scores
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36. #3 Individual Service Plan
17.502(2) (a) Person-Centered Approach –
34 of 39 LIDDAs had one or more findings
(2)(b) ISP Content –
32 of 39 LIDDAs had one or more findings
(4) Integrated Activities –
*This was #7 for average scores
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37. #2 Monitoring and Coordination of ISP
17.502(3) Documenting Progress -
35 of 39 LIDDAs had one or more findings
*This was #5 for average scores
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38. #1 Attachment A-4 Nursing Facility Transitions
(b)(1)(B) Service Planning Team Meeting-
38 of 39 LIDDAs had one or more findings
*This was #2 for average scores
Attachment A-4, 1.5 Service Planning Team
(1) (A-H) SPT Membership Requirements -
35 of 39 LIDDAs had one or more findings
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39. Summary Overall Averages Across Programs Program FY 2017 FY 2018
Quality Assurance
93.10%
97.16%
TxHmL
86.51%
89.36%
HCS
87.79%
87.68%
PASRR
89.05%
84.08%
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40. Outcomes
State-Wide training will soon be developed to provide more information on outcomes
CAO, Curriculum Developers, and Person-Centered Trainers concur that Outcomes may be future or present tense
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41. Outcomes (continued)
Outcomes are a person’s priority wishes and preferences
Outcomes increase the person’s satisfaction with their quality of life.
An outcome describes a result-what the person wants or expects from supports they receive-what a person wants to do, be, achieve.
An outcome may be specific or broad, short-term or long term, depending on the person, as long as it is measurable and reflects the person’s preferences.
Outcomes justify why particular services/supports are included in the plan.
An outcome tells the purpose of the service.
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42. Outcomes (continued)
Focus on whether or not the identified statement is actually a personal outcome for the person. This means:
Look for evidence that the person directed the outcome him/herself (even with needed assistance),
Verify that it is actually an outcome statement and not a service statement,
Ensure the outcome is supported by discovery information, and
Verify that it is something that the person wants/desires for him/herself. 
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43. Summary Overall improvements state- wide
Increased consistency in PASRR
Increased consistency on Outcomes
State-wide training on Outcomes is a priority
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44. Contract Accountability & Oversight/IDD Services
Thank you
Contract Accountability & Oversight/IDD Services
8/30/2019