Quality Management

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

2. Metrics & Analytics Assurances: Qualified Providers LOC Assurances Service Plans Health & Welfare Financial Administrative QIS Agenda

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. 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 Objective

11. 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. SAMS/OMNIA

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

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

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

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

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

20. QMET Resources • The Waiver Reference Guide and FEA standards can be found at • http://www.dpw.state.pa.us/PartnersProviders/PMQ/QMMA/QMET/QMETResources/ Or Type “QMET Resources” into your favorite search engine

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:

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

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.

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

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. 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.”

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 (1-800-757-5042) • Participants may receive a survey in the mail • Complete survey & return in postage paid envelope • Contact Helpline if have questions (1-800-757-5042)

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

35. HW ~ OLTL Helpline Numbers General Information – 1 (866) 286-3636 Information on OLTL programs Enrolled Participants – 1(800) 757-5042 Concerns/complaints with Home and Community Based services Provider Assistance – 1 (800) 932-0939 Billing inquiries, issues, claims processing

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

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

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 09-01-01) • Nursing Facility Clinically Eligible (NFCE) Clarification (APD 09-01-02) • PDA Contract Procurement Requirements for Area Agencies on Aging (APD 09-01-03) • Provider Rates for Services funded through the OBRA, Independence, and COMMCARE Waivers (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

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

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 • Questions • Questions