2. 1 CT DDS Quality Service Review Connecticut Community Providers Association Presented by Fred Balicki, DDS Quality Management Services May 27, 2008

3. 2 Quality System and Service Review – All in One Individuals System Operations Case Managers And Brokers Providers State Case Managers Regional One set of measures – organized in different ways – to evaluate different components - and from different reviewer perspectives - -and MAXIMIZES use of personnel to meet multiple obligations-LPRIC, plan oversight, QA and waiver compliance

4. 3 On-Going Interactions with Case Management and Regional Quality Activities Regional Meetings with Vendors Modify Vendor QI Plan as Needed State QSR Certification Review Modify Vendor QI Plan as Needed Quality Review & Improvement Cycle Vendor Self Assessment Vendor QI Plan

5. 4 Quality Service Review Overview  The Quality Service Review (QSR) is a service review and certification process to determine the quality of service delivered by qualified vendors, and a personal outcome review to assess individual consumers’ experience and satisfaction with services and supports  The QSR will certify private and public service vendors using the new set of quality measures in addition to reviewing regulatory and policy standards  The QSR also serves as a foundation for gathering system wide information for quality review and improvement

6. 5 Why QSR?  Long time goal of the department to enhance quality measures to include personal outcomes and measures related to choice, inclusion and satisfaction  Need a method to certify non-licensed vendors to meet waiver program compliance and build an effective QMS/QI system for: individual supports, all day service types, and new family support services

7. 6 What is Evaluated and By Whom  What  Personal Outcomes  Provider Performance by service type  Case Management  Regional Office Performance  State System of Safeguards, Oversight and Improvement  Who  Case Managers  Regional Based Quality Review Staff  Regional Based QI Divisions  State Certification Review Teams  State Planners and Evaluators  Quality Improvement Councils

8. 7 QSR Constructed from the Bottom Up Physical Plant and Safety indicators Evaluated for 100% of service locations 25% of Individual Plans and associated indicators are evaluated by CM Supervisors 20 Indicators Evaluated for 100% of Individuals by Case Managers Another set of Personal Outcome and Support Indicators assessed for 30% of the people by Regional Reviewers System Review, Analysis & Improvement State Level Certification Review of Public and Private Provider Organizations Sample of Individuals Across All Settings Using All Indicators Revise Policy and Procedure Provider Profile Quality Improvement Councils Plans of Correction or Improvement Target Organization Development & Educational Support

9. 8 Integrating Regional & State Quality Systems Performance measures and expectations are drawn from one pool of quality indicator data Quality Service Review Indicators: Consumer Interview - Observation - Support Person Interview Documentation - Safety Checklist - Application Packet Regional Quality Review Visit Consumer Interview Observation Documentation Safety Checklist Support Person Interview Case Management Review Consumer Interview Observation Documentation Any Observed Non-Compliant Safety Indicators Case Management Supervisor Review Documentation Indicators MY QSR: Web-based Data Management System Interim Tracking System Central Office QSR Certification Review

10. 9 QSR Components  There are 23 Personal Outcomes and 29 Support Expectations found in the QSR tool under the Focus Areas  Personal Outcomes identify desired results regarding individuals’ experiences  Support Expectations identify ways that vendors may assist individuals to achieve those personal outcomes  Seven Focus Areas organize the major sections of the QSR Tool. Planning & Personal AchievementSafety Relationships & Community inclusionHealth & Wellness Choice & ControlSatisfaction Rights, Respect & Dignity

11. 10 QSR Components Continued  Quality Indicators are assessed through:  Consumer Interview – 73, Support Person Interview - 50  Observation – 21, Documentation Review- 57  Safety Checklist – 52, Application Packet – 8  Indicators are aligned according service type. Not all indicators apply to each service type  Interpretive Guidelines provide information from policy and procedure, regulation, best practice and reference specific definitions and sources. They provide examples and discussion for Reviewers and Vendors

12. 11 QSR Content  Regulation  Policy  Best Practice Quality Measures in planning, choice, inclusion, health, behavioral health, rights, safety, and satisfaction

13. 12 Data System Makes It Happen  Dynamic and real time – reports are communicated via web system, reviewed and responded to. Action plans negotiated and tracked on line.  Organized – all findings can be sorted by person, place, provider, service type, assessment methodology, region, state.  Integrated – Findings from other systems entered (Behavior Review, Unusual Incidents, Abuse and Neglect Findings, Mortality Review)  Closes the Loop- manages follow-up without duplicating data entry

14. 13 Reporting, Informing, Monitoring, Closing  Informs Certification Review decisions with longitudinal data instead of one-time snapshot  Informs and permits on- going performance evaluation of providers through trend monitoring by the regions and central office, on-demand  Informs choice of consumers and families by providing easy to read report cards  Informs Quality Improvement Councils with comparative findings from across providers and the state  Regional and State level monitoring activities can target QI needs if trends are noted or trigger enhanced contract oversight activities  Tracks and closes corrections and actions

15. 14  The QSR will include the vendor’s self- assessment and quality improvement planning activities to evaluate the effectiveness of their own service and quality management systems  Findings from all levels of interaction with the department will continually inform on-going quality improvement efforts by vendors and DDS Integrating QSR Certification Process with Existing Activities

16. 15 QSR and Vendor Certification  The QSR for Vendor Certification combines regional review information along with a Vendor’s performance data from incident reporting, abuse/neglect, PRC and HRC, mortality review, financial audits etc. for a biennial retrospective review  A sample of individuals from each service is selected to conduct the consumer and service State Level reviews  Information for consumers and services may validate other findings, reinforce evidence that the Vendor has systematically improved, or suggest that performance may not be consistent with other findings

17. 16 Certification is Service Specific  Individual Support Habilitation- Person’s Own Home  Supports in a Family Home  Self-Directed Supports  Day Service Option  Sheltered Work  Supported Employment – Individual and Group  Individualized Day Support  Family Respite Center  Case Management  Community Living Arrangement, 4 or more Consumers  Community Living Arrangement, 3 or Fewer Consumers  Public Residential Center QSR Tools are Tailored to Each Service

18. 17 Vendor Certification Reporting  Findings are reported for all individuals who have been evaluated by Case Managers and Regional Quality Monitors. The findings are included with the results from a specific sample of individuals for the S tate Level C ertification Review  Service findings are discussed with Vendors in the context of their Quality Improvement Planning  Performance expectations will continue in Consumer Rights, Individual Plan Implementation, Consumer Health and Welfare, and Environmental Safety  Vendor performance benchmarks will be defined and adjusted over time as reviews are completed  Findings will be posted on the DDS web site for Families and Consumers using easy to understand aggregate reports by the QSR Personal Outcomes, Support Expectations, and Focus Area summaries for Vendor services reviewed

19. 18 Additional Components Contributing to Vendor Certification Review The following DDS Quality System components will contribute to Certification Review Findings:  PRC and HRC Committees  Medication Administration Regulations  Incident and Abuse / Neglect Reporting and Follow-up  Mortality Reviews  Resource Administration and Monitoring  Complaints  Financial Audits

20. 19 Licensure Transition to the QSR  CLAs will still need a “license” to operate and maintain DSS funding requirements  This “licensing” will occur at the time of the Vendor Certification QSR for each home  Regional staff complete Environmental Safety Reviews of each home each year. The Quality Indicators address all Physical Environment elements found in regulation  Regional staff also complete a broader review of at least one consumer per home each year  Central Office staff conduct consumer reviews at a sample of locations operated by the Vendor at the time of the Certification Review  Corrective Action Plans will continue to be required for select Quality Indicators that affect Consumers’ Health and Welfare during Regional and State Level Reviews

21. 20 Reference  Quality Service Review  DDS HCBS Waivers  Supports and Services  Provider Forms  DDS Manual – Service Delivery  Fire Safety and Emergency Guidelines For More Information On... Please see the DMR web site: http.www.ct.gov/dds

22. 21 Questions & Answers

23. 22 THANK YOU!