1. PART I: THE PEPSI PROJECT Pamela Sulmer, MS -- DHS Disability Services Division Leah Zoladkiewicz -- DHS Disability Services Division

2. Scope Home and Community Based Waiver Providers: Community Alternative Care Waiver (CAC) Community Alternative Care Waiver (CAC) Community Alternative for Disabled Individuals Waiver (CADI) Community Alternative for Disabled Individuals Waiver (CADI) Developmental Disability Waiver (DD) Developmental Disability Waiver (DD) Traumatic Brain Injury Waiver (TBI) Traumatic Brain Injury Waiver (TBI) Elderly Waiver (EW) Elderly Waiver (EW)

3. What Defines HCBS Quality? Participant-Centered Access & Service Planning Provider Capability & Service Capacity Provider Capability & Service Capacity Participant Safeguards & Rights Protections Participant Safeguards & Rights Protections Positive Service Outcome & Participant Satisfaction Positive Service Outcome & Participant Satisfaction

4. Core Components of a Quality Assurance System Service Providers meet Compliance Standards Service Providers meet Compliance Standards Timely Response to Client Complaints Timely Response to Client Complaints Tools to Prompt Informed Client Choice Tools to Prompt Informed Client Choice Service Delivery Monitoring & Systems Improvement Service Delivery Monitoring & Systems Improvement

5. Minnesota: A Statewide System Locally-Directed / Locally-Executed State-Directed / State & Locally-Administered

6. Fee For Service Contracts Establish Provider Standards Establish Provider Standards Set forth Service Delivery Requirements Set forth Service Delivery Requirements Lay the Foundation for Oversight & Monitoring Lay the Foundation for Oversight & Monitoring Define the Provider Field Define the Provider Field

7. Elimination of Local Contracts Centralized HCBS System per CMS Mandate Centralized HCBS System per CMS Mandate Uniform Provider & Service Delivery Standards Uniform Provider & Service Delivery Standards Consistent Monitoring & Oversight Consistent Monitoring & Oversight Well-Coordinated Administrative Partnership Well-Coordinated Administrative Partnership

8. Waiver Provider Quality Management: The Vision State Provider Qualifications & Service Standards State Provider Qualifications & Service Standards Consistent Oversight & Compliance Assurance Consistent Oversight & Compliance Assurance QUALIFIED PROVIDER OPTIONS State Provider Qualifications & Service Standards State Provider Qualifications & Service Standards Consistent Oversight & Compliance Assurance Consistent Oversight & Compliance Assurance QUALIFIED PROVIDER OPTIONS Provider Performance Beyond Compliance Provider Performance Beyond Compliance Client Experience Evaluation & Reporting Client Experience Evaluation & Reporting OPTIMAL SERVICE EXPERIENCE Provider Performance Beyond Compliance Provider Performance Beyond Compliance Client Experience Evaluation & Reporting Client Experience Evaluation & Reporting OPTIMAL SERVICE EXPERIENCE

9. The Whole Provider Picture Provider Meets Qualifications & Enrolls Provider Complies with Service Standards Provider Performance & Public Reporting

10. The PEPSI Initiative Phase 1: Review Local Contract Elements Phase 1: Review Local Contract Elements Phase 2: Streamline & Strengthen Standards Phase 2: Streamline & Strengthen Standards Phase 3: Design an Integrated Compliance Assurance System Phase 3: Design an Integrated Compliance Assurance System Phase 4: System Development towards System Transition Phase 4: System Development towards System Transition

11. StakeholderInvolvement Stakeholder Involvement Solicitation of Workgroup Members Solicitation of Workgroup Members Work Group Structure Work Group Structure Work Group Process Work Group Process

12. Phase IProvider Requirements Phase I Provider Requirements Reviewed Components of Model Contract /Current MHCP Provider Agreement Reviewed Components of Model Contract /Current MHCP Provider Agreement Recommended Elements to Move Forward into Uniform Provider Requirements Recommended Elements to Move Forward into Uniform Provider Requirements Established Universal Provider Requirements Established Universal Provider Requirements

13. Universal Requirements Training Direct Care Staff Training Direct Care Staff Training Owners/Managers Training Owners/Managers Policies and Procedures Policies and Procedures Insurance Insurance

14. Phase II Provider Requirements Evaluated Current standards/Qualifications for Unlicensed Waiver Services Evaluated Current standards/Qualifications for Unlicensed Waiver Services Recommended Enhancements for Standards/Qualifications Recommended Enhancements for Standards/Qualifications

15. Service Specific Requirements Training Training Professional licensure/certification/degree Professional licensure/certification/degree Policies and procedures Policies and procedures Background Checks Background Checks Insurance Insurance

16. Compliance Assurance System Universal & Customized Standards at the Center Universal & Customized Standards at the Center Ultimately 4 Distinct Functional Components Ultimately 4 Distinct Functional Components State-Directed / Jointly Administered State-Directed / Jointly Administered

18. Provider Qualification Review Who are You? How are You Qualified to Deliver Service(s)? Who are You? How are You Qualified to Deliver Service(s)? Do You Agree to Comply with Required Policy and Procedures? Do You Agree to Comply with Required Policy and Procedures? Conducted by the State Prior to Enrollment Conducted by the State Prior to Enrollment Qualified HCBS Provider Directory Qualified HCBS Provider Directory

19. Routine Provider Review Review of Service Operations in the Field Verification of Assurances Provided at Enrollment Are you Complying with Required Standards of Practice & Adhering to the Policies You’ve Adopted? State-Directed / Largely Locally Conducted

20. Complaint-Driven Review Threshold Health & Safety, Participant Rights, Service Delivery & Operational Management Complaints Rise to Uniform Management Level Threshold Health & Safety, Participant Rights, Service Delivery & Operational Management Complaints Rise to Uniform Management Level Locally-Administered “State-Directed” Complaint Discovery, Remediation, Improvement Locally-Administered “State-Directed” Complaint Discovery, Remediation, Improvement Augments Existing Centralized Complaint Systems Augments Existing Centralized Complaint Systems

21. HCBS Compliance Assurance System Goals Compliance Assurance via Reasoned Review Compliance Assurance via Reasoned Review Uniform Management & Oversight Uniform Management & Oversight Leveraging of Expertise & Capability towards Productive Administrative Partnership Leveraging of Expertise & Capability towards Productive Administrative Partnership Efficiencies Maximized at Every Level Efficiencies Maximized at Every Level

22. Achieving Consistent Oversight Activity Centralized System with Well-Directed Division of Labor Centralized System with Well-Directed Division of Labor Policy-Embedded IT Drives Review & Response Policy-Embedded IT Drives Review & Response System Supports Administrative Functions System Supports Administrative Functions Value Added for State and Local Partners Value Added for State and Local Partners

23. Essential Functions Provider Screening, Service Monitoring, Transparent Reporting Provider Screening, Service Monitoring, Transparent Reporting Systems-Level Review of Local Activity Systems-Level Review of Local Activity ID & Target Improvement Opportunities ID & Target Improvement Opportunities Efficient Data Management & Program Reporting Efficient Data Management & Program Reporting

24. Develop Provider Qualification Review Certify/Enroll Providers MN HELP Directory Contract Elimination 2012 2013 Develop Complaint Management Development and Rollout Vision Develop Routine Field Review 2014 Q-1

25. Work Ahead Policy Development to Support Monitoring Functions & State/Local Coordination Policy Development to Support Monitoring Functions & State/Local Coordination Business Process Analysis & Rework Supporting Transition to Centralized System Business Process Analysis & Rework Supporting Transition to Centralized System Development of Core IT Infrastructure Development of Core IT Infrastructure Development of Training to Support Implementation Development of Training to Support Implementation

26. Upshot Participants: Access to Qualified Providers Providers: Uniform Statewide Requirements Eligible if Qualified & Compliant Local Partners: Efficient, Consistent Oversight Access to Statewide Provider Data Access to Statewide Provider Data

27. Additional Opportunities Lead Agency/Provider Training Opportunities & Delivery Methods- Tues. 8:30 AM Commons Doubletree New Licensing Standards – Tues. 8:30 AM Riverview Rate Setting Methodologies Overview – Tues. 1:30 PM Ballroom A Provider Enrollment for HCBS Waiver Providers – Wednesday 9:45-12:00 & 12:45-3:00 McDonnell B

28. Resources PEPSI Website: http://www.dhs.state.mn.us/dhs 144650 PEPSI Email: PEPSI Email: DHS.DSD.pepsi@state.mn.us DSD Resources : DSD Resources : http://www.dhs.state.mn.us/id_003540 MNHelp: MNHelp: http://www.mnhelp.info