1. Office of Long Term Living Quality Management, Metrics & Analytics

2. Agenda Metrics & Analytics Assurances: Qualified Providers
LOC Assurances
Service Plans
Health & Welfare
Financial
Administrative
QIS
Metrics & Analytics Burd & DeSantis
Assurances:
Qualified Providers-Diane
LOC Assurances-Carol
Service Plans-Melanie
Health & Welfare-Melanie
Financial-Melanie
Administrative-Melanie
QIS-Melanie
Choice and ODCDS-McNamara

3. Metrics and Analytics Division
Mission and Functions

4. Division Mission
Provide timely and accurate reporting and analyses for decision makers in support of the overall goals and objectives of the PA Department of Aging and Office of Long Term Living. Administer the Social Assistance Management System (SAMS) and Omnia in support of the Aging Network to assure data integrity for Aging and NHT Programs and Operations.

5. Division Functions
Provide cost and effectiveness analyses of current programs, proposed modifications to current programs and new programs
Provide census and demographic data support for PDA/OLTL
Prepare or assist program offices in preparation of mandatory state and federal reports e.g. CMS 372 Reports, NAPIS Report
Support QM with samples, surveys and reports for annual assurances
Support QM in the design, implementation, administration and use of QMMU Monitoring Database

6. Division Functions (cont’d)
Prepare Benchmarking reports and Dashboards to support ongoing evaluations of AAA’s, Providers and Waiver Program operations and Aging Programs
Provide Administration, Technical and User Support for SAMS and Omnia
Develop, prepare and publish procedures for implementation of new programs and policies in SAMS
Prepare and conduct training for SAMS and Omnia users – On-site, Webinars, etc.
Design and implement new Assessment Forms, modify existing forms as required

7. Division Functions (cont’d)
Represent PDA/OLTL needs and interests regarding Information Technology issues
Test and evaluate new versions of SAMS, Omnia and HCSIS
Test and evaluate SAMS, Omnia, and DPW Enterprise Data Warehouses for data integrity
Survey design and analysis support
Provide technical database and report creation support for PDA/OLTL Bureaus
Develop an integrated Incident, Complaint, Hearings and Appeals Database and Reporting System

8. Management Reports
Performance Reports - Consumers served, units delivered, dollars expended, etc
Demographic Reports – Consumer and provider characteristics
Scorecard – Measures compared to established targets
Outcomes Analyses – What you got for what you spent
PDA/OLTL Custom Reports System – Library of reports for service models utilizing SAMS and Omnia
EDW Reports - Library of reports for service models utilizing HCSIS

9. Quality Management, Metrics and Analytics
Data Collection
and Reporting Section

10. Objective
Provide the OLTL Network with Training, Technical Assistance and Resource Material to enhance the skills of 2,000 plus SAMS/OMNIA Users in order to promote quality and accurate data entry

11. SAMS/OMNIA
Two separate Databases. OMNIA serve as the repository for assessments and SAMS serves as the repository for demographics, service programs and service delivery information.
Each case record within the databases are automated clinical records.

12. The OLTL Network Assessors Care Managers/Service Coordinators
Protective Service Workers
SAMS Administrators
Network Supervisors
Network Administrators
Over and Under 60 NHT Transition Coordinators

13. Resources Provided to the Network
Webinars
Training Manuals
Videos
Dashboards
Ad Hoc Requests

14. Where the Resource Material is Located
Unsecured FTP Site for access by the AAA Network
Allshare Drive (S:) Drive for access by PDA and OLTL staff
OLTL Website

15. Qualified Providers Assurance
QMET Update
Current Monitoring Status & Waiver Standards Review

16. Current Monitoring Status
The QMET has completed all monitoring visits of HCBS providers to date (328). In addition to waiver provider visits QMET has completed:
Abbreviated On-Site Monitoring Visits
36 F/EA On-Site Reviews
100 follow up visits
150 StIPS
Remaining Standards Implementation Plans are being completed and approved with follow up of plans being scheduled

17. What is QMET looking at?
The current services agencies are providing to consumers against the standards outlined in the Waiver Reference Guide.
The F/EA standards as currently approved
QMET is only reviewing Waiver programs for standards that are listed in the waiver for the services the provider actually provide to consumers
The FEA standards finalized on 12/17/08. Available on QMET website.

18. Where are the QMETs finding?
Overall compliance with the waiver program standards is excellent.
Most commonly missed standards are
Distributing hotline number to consumers
Incident reporting was inconsistent with waiver requirements
Billing/ Bookkeeping Errors
Documentation

19. What’s Next for the QMETs?
Review of the waiver monitoring tool and provider letter
Continue scheduling of on-site monitorings
Follow up of Corrective Action Plans (StIPS)
Clarify how providers are expected to monitoring their subcontractors
Now that the QMET has had the opportunity to work with the tool in the field, we want to rephrase some of the questions so they are more logical and more precise. We also recognize the information requested in the initial letter was not as precise as it could be. We are working to make ourselves clearer. (The lists we request of providers were not worded in a way that we were getting the information that we wanted, so we are trying to get the language right. Currently, when the information is not what we need, we call providers and work out the details so we get what we need). Any changes will
Providers will continue to receive a 30 day notice prior to our visit. A thanks to all providers for working so closely with us as we ask for information prior to our arrival. By providing timely and accurate information, our visits have been smooth and efficient.
QMET recognizes that AAAs and under 60 providers need more clarification on what is expected of them in regards to agencies they subcontract with. We are working on information and training materials for AAAs and under 60 providers that clearly explain the waiver requirements as to what subcontractors need to meet and who is monitoring those subcontractors to ensure they meet CMS expectations as waiver providers.

20. QMET Resources
The Waiver Reference Guide and FEA standards can be found at Or
Type “QMET Resources” into your favorite search engine
QMET protocols also found on website.

21. Level of Care Assurance

22. Level of Care
Based on the review of the data from the past 24 months on the Level of Care performance measures the following changes are being submitted to CMS in the required 372 documents regarding remediation:
The level of care performance measure reports have been run and the data aggregated over the first 6 months of the calendar year. We have also begun to obtain our first round of non-compliance details information for review.

23. Level of Care Next Steps
The performance measure for sub-assurance a.i.c is being clarified to more accurately reflect the information being tracked and trended.
The frequency of the reports being run for sub-assurance a.i.a is being changed to every 8 weeks.
Remediation is being clarified to more accurately reflect current OLTL process.

24. What Does this Mean to You?
As a participant, advocate or stakeholder
As a Provider of enrollment, level of care assessment or supports coordination/care management
OLTL
The changes in the performance measures and timing should not have any impact on consumers.
The changes mean that providers will no longer be sent or required to complete a Standards Implementation Plan for each month that you receive a non-compliance notice per report
Monitoring activities by the QMET’s will include information provided on the individual providers performance with the level of care sub-assurances.
Bureau of Individual Supports will be provided information on non-compliance

25. Service Plan Assurance

26. Service Plan Assurance
QMMA and BIS implemented the standardized Individual Service Plan in October 2010
Training on the new forms and processes were completed prior to implementation and remain on going as needed
Mailing/analysis of consumer satisfaction surveys has started.
Through the recent Aging and Attendant Care Waiver renewals and work plans, the Service Assurance has many enhancements planned to standardize the way service plans are developed and reviewed. When the work plan steps are completed, the data needed for the service plan performance measures regarding service plan development and review can be obtained.

27. What does this mean to you?….
Service Plans
Providers and OLTL staff can expect training on new forms and processes for service plans to be on going as needed
Participants can expect consistent forms and processes will be used across the state
OLtL staff

28. Satisfaction Surveys One Survey for all Waivers
Reduce Mailings and Participant Intrusion
Gather Similar Facts on each Waiver

29. On Going Survey Review
Review of survey questions wording for understanding
Add questions based on need for more information
Results are one component for determining that all participant needs are met and services are received

30. Mailings will be every 4 months
Mailing Cycles for Satisfaction Surveys (New Participants / Ongoing Participants)
Mailings will be every 4 months
Every 4 months waiver participants who enrolled in that time period will receive a survey
Every 6 months participants who have received HCBS waiver services for over one year will receive an Annual survey

31. Participant Satisfaction Surveys
New questions will be added to surveys for Health and Welfare Assurance as needed to gather appropriate information. Such as:
“I know how to report abuse, neglect, or exploitation including the use of restraints and other restrictions.”
Possible answers are Yes, No, I don’t understand, & N/A

32. What does this mean for you?….
Surveys
QMU staff will answer questions about the survey and analyze responses
Providers may receive questions about the surveys
Refer questions to Helpline ( )
Participants may receive a survey in the mail
Complete survey & return in postage paid envelope
Contact Helpline if have questions ( )
OLtL staff

33. Health & Welfare Assurance

34. Health & Welfare Assurance Update
Operational Functions
Incident Data for All Waivers available for OLTL use
Quality Assurance Helpline
Quality Assurance Helpline Database
Clarification and revision of Performance Measures
Can Track and trend aggregated data for Incidents (Aging only) & Complaints
Helpline – Intake for complaints
Rewording of PMs and elimination of one PM

35. HW ~ OLTL Helpline Numbers
General Information – 1 (866)
Information on OLTL programs
Enrolled Participants – 1(800)
Concerns/complaints with Home and Community Based services
Provider Assistance – 1 (800)
Billing inquiries, issues, claims processing
Participants are encouraged to work with their provider and or service coordinator - First level of complaints should be addressed with provider and Service Coordinator. If not able to resolve then call the helpline.

36. What does this mean to you?....
Providers document incidents and may be contacted for additional information during the investigation of complaints and incidents. Remediation actions may be required of providers.
OLTL staff document and research complaints and incidents, including documentation of the resolution.
Participants or their representative's use the 800 line to report complaints and issues they are unable to resolve at the local level. Participants may be contacted to discuss complaints or incidents.
Final OLTL Incident policy under development
Complaints & Incidents

37. Financial Accountability Assurance

38. Financial Accountability Assurance
Paid Claims Review report
No claims paying with incorrect procedure codes
Bureau of Provider Support developing internal protocols for remediation which can include recoupment
The Bureau of Provider Support is processing a paid claim review report, which compares paid claim against allowable procedure codes. The report is analyzed and sent to QMU for our PM tracking and trending.

39. Financial Accountability Assurance
Quality Management and Efficiency Teams (QMET) Provider Claims Review
Probe sampling of claims
All Provider reviews completed, those out of compliance are correcting issues via a Standards Implementation Plan, (StIP).

40. What does this mean for you?….
Provider, OLTL BPS staff and BFO staff notified if billing errors discovered through financial report or QMET review
Correction(s) initiated for identified issues and to prevent reoccurence
Participants responsible for correct authorization of time sheets

41. Administrative Authority Assurance

42. Administrative Authority Assurance
As reported by the QMEU
30 Policies or Directives have been initiated since 01/01/2009, including:
Interim Incident Management Procedures for the Aging Waiver (APD )
Nursing Facility Clinically Eligible (NFCE) Clarification (APD )
PDA Contract Procurement Requirements for Area Agencies on Aging (APD )
Provider Rates for Services funded through the OBRA, Independence, and COMMCARE Waivers (various #s)
First bullet refers to - One of the PMs for AA refers to the QMET monitoring which you heard about previously
Provider rates policy is one policy with various #s

43. What does this mean for you?…..
Providers and all OLTL staff need to obtain, review and implement policies as applicable.
Participants need to be aware that new policies may be issued at any time impacting the waiver and their services.

44. Quality Improvement Strategy

45. Quality Improvement QMU monitors waiver basics
Enrollment
Length of time for enrollment
Length of time for start of services
Will continue to add new focus areas
QMU will continue to monitor some performance measures after they are replaced
QMU beginning to go beyond the CMS mandated assurances to monitor other quality focus areas such as access, participant rights and responsibilities, etc.
When some PMs appear to lose relevance – i.e. no problems or issues are ever found – they may be replaced but will still be monitored

46. QIS Enhancements QIS expected to change
Changes to quality sections of approved 1915(c) waiver applications
Listed on annual CMS 372 reports
Deletion of 2 performance measures
AA – % new policy monitored and remediated by non state entities
HW – # providers who fail to report incidents
CMS expects quality improvement strategies to change – it is part of the nature of the strategy that you continually review and assess the efficiency and quality (are you getting the results you want?) and make changes for improvement.
OLTL has changed many of the performance measures that were approved in the recent Aging and ACW renewals.

47. OLTL Quality Council
First meeting was an orientation meeting held in June 2009
First official meeting was held in August 2009
Comprised of Participants, Participants Family Members, Provider Agencies, AAA’s, Aging Community Representatives, OLTL Staff

48. Quality Council
Meetings since have been held quarterly in the months of February, May, August, and November.
Minutes and information are posted on the website.

49. What does this mean for you?…..
Providers and OLTL staff may notice new reports, remediation and system improvement efforts that are not strictly related to the CMS Assurances
Participants may experience increased quality of services and service delivery due to remediation and system improvements
Everyone can follow the Quality Council activities on the website.

50. Questions
Questions