1. rev 03/2007 1 MI Choice Quality Assurance Review (MICQAR) Center on Frail and Vulnerable Elders The University of Michigan School of Nursing Ann Arbor, Michigan Donna Algase PhD, RN, FAAN, FGSA: Principal Investigator Rosemary Ziemba, PhD, RN: Project Director

2. rev 03/2007 2 MICQAR GOAL for Entrance Conference To educate attendees on the MICQAR review process for selected Center for Medicare/Medicaid Services (CMS) standards.

3. rev 03/2007 3 Objectives, Entrance Conference: Attendees will… Identify the Quality Assurance Measures for MI Choice Waiver. Understand the HCBS CMS Quality Framework and the implications for the MI Choice Waiver. Engage in dialog to improve systems of supports and services coordination for the participant.

4. rev 03/2007 4

5. 5 The MICQAR Reviewers Karen Hesselberg, MA, RN Claire Michelini MS, RN Rosemary Ziemba, RN, PhD Audrey Smith, RN Sue McVeigh, RN Theresa Staton, RN

6. rev 03/2007 6 Michigan Department of Community Health Mike Head- Long Term Care Director James Schwartz Elizabeth Gallagher Pamela McNab Carol Hansen, RN Laurie Goldi, RN

7. rev 03/2007 7 History of MICQAR Began in January, 2005 University of Michigan School of Nursing was asked to conduct Quality Assurance Reviews Only program in USA to contract with a school of nursing Major innovations Aim is to be more educational, & less regulatory Resource model to share model practices Teach students in health professions about MI Choice Automation of review tool 2006: Automation into PICQAR organized standards from MDCH/ CMS Quality Framework to reflect reviewer and care management work flow.

8. rev 03/2007 8 The Review Process Review period: October 1, 2005 through September 30, 2007 (looking at 10/05 to present for home visits) Chart reviews Simple random sampling Standards & sources Home visits Participant interviews Schedule and forms Exit conference - MICQAR sends reports to MCDH. MDCH sends two separate reports (FY 2006 & FY 2007) at the same time to the Waiver Agency. Waiver Agency has 30 days to respond with a SINGLE corrective action plan to cover both years.

9. 9 MICQAR Review Tool Changes related to automating the tool. Scoring 0-Not evident 1-Partially evident 2-Evident 3-Exemplary Practice Not Applicable

10. rev 03/2007 10 Identification of Model Practices PILOT TESTING: A rating of “3” will be given for exemplary practice. Model practices will be shared in the Exit Conference.

11. rev 03/2007 11 The MICQAR Website Live Date: To Be Announced The MICQAR website will include: News for Waiver agencies Literature and resources Meeting minutes and notices (QMC, PCP, etc..) Model Practices Your suggestions

12. rev 03/2007 12 Exit Conference Purpose The exit conference is an overview of major findings summarized by the MICQAR team Exemplary or model practices Challenges faced by the agency Opportunities for improvement Opportunity for Agency feedback

13. rev 03/2007 13 MICQAR DISCLAIMER To be read at the entrance and exit conference: (DEFINITION: Exit conference takes place after all the specified records and home visits are completed. The purposes of the exit conference are to: 1) summarize MICQAR findings and impressions; 2) elicit Agency response to findings; 3) provide opportunity for Agency to comment on review process. The exit conference is informal and unofficial. That is, the complete and official recommendations and citations will be provided to the Agency pending full analysis of MICQAR ratings and commentary by the Michigan Department of Community Health. However, in the exit conference, the RN reviewers will exercise informed judgment to provide an overview of clinical, managerial, and administrative characteristics that lead to best practices, minimal standards, or sub-standard practices. Please note: MICQAR staff will report serious situations (e.g., neglect, abuse, or exploitation) requiring immediate attention to WA when identified during the review. MICQAR staff will provide CM’s opportunity to provide additional information on- site. MICQAR staff will provide feedback that can potentially improve services for specific participants as applicable during the case analyses. MICQAR staff will verify opportunities for improvement in individual participant cases as they arise. Communication between reviewers and WA program and QA directors will serve throughout the review to prevent misunderstanding or oversight of additional documentation, etc.

14. rev 03/2007 14 Questions for you.. Identify the Care Management Model used in your agency What is your Service area? Please furnish a list of Contract Providers and explain how choice is provided Tell us how your participant record is organized Please furnish us with any NEW additions to your admission packet and forms.

15. rev 03/2007 15 Other critical information needed… Area restaurant recommendations!

16. rev 03/2007 16 MICQAR Staff to contact Rosemary Ziemba, Project Director rzie@umich.edu 734 763-0923 Mobile phone: 313 303-1285 rzie@umich.edu

17. rev 03/2007 17 Who to call if Questions during the review. Call or email Elizabeth Gallagher MDCH gallaghere@michigan.gov

18. rev 03/2007 18 Last words… …from you In about two weeks, agency will receive forms with which to evaluate MICQAR. The evaluations will not affect your review results. THANKS!!