1. ODP’s Waiver Quality Strategy Where does IM4Q fit in? Dolores Frantz, ODP Diana Ramirez, ODP Jennifer Fraker, ODP William Posavec, ODP

2. HCBS Quality Framework Program design sets the stage for achieving desired outcomes. Program design addresses fundamental program requirements including: service standards, provider qualifications, assessment, service planning, monitoring participant health and welfare, and critical safeguards (e.g., incident reporting and management systems). 2

3. 3 Waiver Assurances Level of Care Determinations Service Plans Qualified Providers Health and Welfare Administrative Authority Financial Accountability

4. CMS Vision of CQI: DDRI Model DESIGN Plan for and set stage for achieving positive outcomes DESIGN Plan for and set stage for achieving positive outcomes DISCOVERY Find positive and negative outcomes in a systematic, timely manner DISCOVERY Find positive and negative outcomes in a systematic, timely manner REMEDIATION Address negative outcomes in a timely manner REMEDIATION Address negative outcomes in a timely manner IMPROVEMENT Improve quality via systemic changes IMPROVEMENT Improve quality via systemic changes CONTINUOUS CYCLE This is where data analysis comes in 4 4

5. CMS Vision of CQI: DDRI Model The National HCBS Quality Enterprise, a Grant Funded by CMS 5

6. Appendix H: Quality Improvement Strategy Sums up how, where, and by whom statewide performance results will be compiled and trended over time each year for review and any systemic improvement activities needed Brings together data for analysis from a variety of sources that support the QIS, including IM4Q/NCI data, HCSIS, PROMISe, AE, Provider, and SCO Monitoring data, and data from ad hoc databases Improvement 6

7. 7 CMS Expectations for QIS Performance measures required for all assurances and sub-assurances Should be continually reaching 100% compliance Should be able to aggregate remediation and show how quickly issues are resolved Should be able to describe and document methods of remediation Should be able to describe relevant quality improvement initiatives (training, policy change, etc.) Can use consumer surveys in conjunction with all other data

8. Remediation The National HCBS Quality Enterprise, a Grant Funded by CMS 8

9. 9 Service Plans Assurances The State demonstrates it has designed and implemented an effective system for reviewing the adequacy of service plans for waiver participants. Sub-Assurance A: Service Plans address all participants assessed needs (including health and welfare risk factors) and personal goals, either by the provision of waiver services or through other means. Sub-Assurance B: The State monitors service plan development in accordance with its policies and procedures.

10. Sub-Assurance C: Service plans are updated/ revised at least annually or when warranted by changes in the waiver participant’s needs. Sub-Assurance D: Services are delivered in accordance with the service plan, including the type, scope, amount, duration and frequency specified in the service plan. Sub-Assurance E: Participants are afforded choice between waiver services and institutional care, and between/among waiver services and providers. 10

11. 11 Service Plans Subassurance A Consolidated Waiver Data Source: AEOMPCycle 1 (CY 07-08) Cycle 2 (CY 09-10) Cycle 3 YTD (FY 11-12) n% Compliant n% Compliant n Q2.A. All assessed needs are addressed in the ISP. 43593%22195% Q4.A. The outcomes listed on the ISP relate to an identified preference. 125491%43597%22198%

12. 12 Service Plans Subassurance A Consolidated Waiver Health and Welfare risk factors are assessed; Risk factors are mitigated where appropriate Data Source: AEOMP Cycle 1 (CY 07-08) Cycle 2 (CY 09-10) Cycle 3 YTD (FY 11-12) n% Compliant n% Compliant n Q1.0H. Risk assessment is completed. 22199% Q1.0I.01. If yes, services and supports to mitigate identified are incorporated into the ISP. 19995%

13. 13 Service Plans Subassurance B Consolidated Waiver Service Plan Development is Monitored Data Source: AEOMP Cycle 2 (CY 09-10)Cycle 3 YTD (FY 11-12) n% Compliant n% Compliant Cycle 2: Q7.B. Do you attend your ISP meeting? 26699.6% Cycle 3: Q6.A. There is documentation that the waiver participant attended the ISP meeting. 22196% Cycle 2: Q7.A. There is documentation that the required members of the team were invited to the ISP meeting. 43587% Cycle 3: Q6.B. There is documentation that the required members of the team attended the ISP meeting. 22194%

14. 14 Service Plans Subassurance B Consolidated Waiver Service Plan Development is Monitored Data Source: AEOMP Cycle 2 (CY 09-10)Cycle 3 YTD (FY 11-12) n% Compliant n% Compliant Cycle 2: Q3.B. Service frequency is indicated in the ISP. 43583% Cycle 3: Q3.A. Service frequency is indicated in the ISP. 22193% Cycle 2: Q1.C. Were all services and supports in the approved ISP? 43595% Cycle 3: Q1.C. Were all services and supports in the approved ISP? 22198%

15. 15 Service Plans Subassurance B Consolidated Waiver Service Plan Development is Monitored Data Source: AEOMP Cycle 2 (CY 09-10)Cycle 3 YTD (FY 11-12) n% Compliant n% Compliant Cycle 2: Q8.B.1. The AE authorizes services consistent with the service definitions. 39394% Cycle 3: Q7.0A. The AE authorizes services consistent with the service definitions. 22197% Cycle 2: Q8.B.2. The AE authorized qualified providers to deliver all services authorized in the ISP. 43597% Cycle 3: Q7.0C. The AE authorized qualified providers to deliver all services authorized in the ISP. 221100%

16. 16 Service Plans Subassurance E Consolidated Waiver Choice of Services is offered Data Source: AEOMP Cycle 1 (CY 07-08) Cycle 2 (CY 09-10) Cycle 3 YTD (FY 11-12) n% Compliant n% Compliant n Q50.A Documentation indicates choice between and among services was offered to the individual/family. 42259%31847% Q24.0A. There is documentation that indicates choice between and among services was offered to the individual/family. 22195%

17. 17 Service Plans Subassurance E Consolidated Waiver Choice of Providers is offered Data Source: AEOMP Cycle 1 (CY 07-08) Cycle 2 (CY 09-10) Cycle 3 YTD (FY 11-12) n% Compliant n% Compliant n Q51.A Documentation indicates choice of willing and qualified service providers was offered to the individual/family. 72656%42167% Q25.0A. There is documentation that indicates choice of willing and qualified service providers was offered to the individual/family. 22195%

18. 18 Service Plans Subassurance D Consolidated Waiver Services and Supports are delivered Data Source: AEOMP Cycle 2 (CY 09-10)Cycle 3 YTD (FY 11-12) n% Compliant n% Compliant Cycle 2: Q1.C.2. Based on AEO Review of records, all services and supports in the approved ISP were received. 43587% Cycle 3: Q1.0D.01. Based on HCSIS monitoring reports, all services and supports in the approved ISP were received. 22195%

19. 19 Data Source: IM4Q Individuals receive services they need Services Delivered in Accordance with the Plan FY 06-07FY 07-08 Percent of waiver participants who indicated they received the services they need n% Compliantn Consolidated Waiver 88878%110779%

20. Individuals receive services they need 20

21. Individuals receive services they need 21

22. Individuals receive services they need 22

23. Individuals receive services they need 23

24. 24 Health and Welfare The State demonstrates, on an ongoing basis that it identifies, addresses and seeks to prevent instances of abuse, neglect and exploitation.

25. 25 Health and Welfare Consolidated Waiver Data Source: HCSIS Data Extraction Date: 06/20/12 (100% Review) FY 06-07 FY 07-08 FY 08-09 FY 09-10 FY 10-11 Number of Confirmed Incidents of Abuse, Neglect, and Exploitation Abuse 423447481549588 Individual to Individual Abuse 4029313344 Other investigated injuries determined to be abuse 6560638378

26. 26 Consolidated Waiver Data Source: HCSIS Data Extraction Date: 06/20/12 (100% Review) FY 06-07 FY 07-08 FY 08-09 FY 09-10 FY 10-11 Number of Confirmed Incidents of Abuse, Neglect, and Exploitation Neglect 646653770887974 Rights Violation 10574131179128 Misuse of funds 324260262313 Health and Welfare

27. 27 Health and Welfare Critical Incident Review # and % of critical incidents in which prompt action (demonstrated within 24 hours) is taken to protect the participant’s health, safety and rights # and % of AEs that review incidents within 24 hours of the report # and % of critical incidents finalized within the required timeframe (30 days)

28. 28 Health and Welfare Investigation of Critical Incidents # and % of AEs that completed investigations in accordance with ODP standards # and % of confirmed critical incidents where corrective actions were carried out or planned by the appropriate entity within the required timeframe # and % of AEs that maintain documentation of incident management training

29. 29 Consolidated Waiver Data Source: HCSIS Data Extraction Date: 06/20/12 (100% Review) FY 06-07 FY 07-08 FY 07-08 FY 07-08 FY 08-09 Number of Incidents of Restraints 2,8642,8792,5363,2593,053 Unduplicated Count of Individuals with Restraints 369355344342330 Number of Medication Errors 7,9848,3888,1728,4058,458 Health and Welfare

30. 30 Health and Welfare Training in Reporting Abuse # and % of waiver participants who received information about reporting abuse, neglect, and exploitation.

31. 31 Individuals Feel Safe Consolidated Waiver Data Source: IM4QFY 06-07FY 07-08 n%n% Percent of individuals who feel safe in their homes 154181%193080% Percent of individuals who feel safe during day activity 138887%166290% Percent of individuals who feel safe in their neighborhood 154584%225472%

32. Individuals Feel Safe at Day Activity 32

33. Individuals Feel Safe at Day Activity 33

34. Individuals Feel Safe at Day Activity 34

35. Individuals Feel Safe at Day Activity 35

36. 36