Department of Mental Retardation

3. Connecticut DMR Transition to a New Quality System Presented by Mary McKay and Sheila Mulvey with assistance from Beth McArthur

5. State of Connecticut Connecticut 169 towns 3.5 million residents Town Government Local Education Associations Limited county focus State agencies with regional catchments Department of Mental Retardation Budget $860,000,000+ 15,000+ consumers 4,000 additional B-3 150 private agencies Central Office and 3 Regions administer all funding and services State operates small percent of services

7. Connecticut DMR Governing Statutes Narrow definition of consumer eligibility (MR only) Other disability populations not served (Autism Pilot) Services to persons under �care and custody of Commissioner or designee� historically meant in facilities State dollars fund all services; CMS federal match for waivers goes into CT General Treasury not directly to DMR or providers

9. HCBS Waivers Administered by Connecticut DMR Comprehensive Waiver Since 1987, as an alternative to ICF/MR facilities Expired September 2005; new Comp Waiver 10/1/05 Authorized services package >$52,000 includes residential and day habilitation; respite; family training; environmental modifications; transportation; specialized medical equipment, etc. Option to self-direct 4,351enrollees; 5,117 cap (at end of three years) FFP rate 50%

10. HCBS Waivers Administered by Connecticut DMR Individual & Family Supports Waiver Applied under federal Independence Plus initiative CMS approval February 2005, reviewed September 2006 Authorized service package up to $52,000 includes individual support habilitation; adult companion, respite, PERS; transportation; consultative services; interpreter; vocational services; environmental modifications, etc. Option to self-direct 3,185 enrollees; 3,693 cap (at end of three years) FFP Rate 50%

11. Traditional Quality Management Licensing / Certification Regulations Groups homes (Community Living Arrangements or CLA�s) Community Training Homes (CTH�s) ICF/MR�s No formal quality assurance requirements Supported Living Services Employment and Day Programs Respite Care Self-Directed Supports

14. CMS Systems Change Grants2003 DMR received two grants to fund the systems change �QA/QI� Grant $500,000 over 3 years Development of Self-Advocacy initiative Development of P&P for safeguards in own or family homes Design QSR data application system Independence Plus Grant $175,000 over 3 years Development of CT Level of Need (LON) assessment tool Development of Individual Budget resource allocation methodology

24. Case Manager Role Contact with all consumers served Fundamental role is Individual Plan Quality reviews cover ~ individual interview regarding satisfaction observation of waiver service delivery record review Safety / environmental check in some settings System also measures case management as a state service (DMR and Medicaid State Plan)

25. Family and Consumer Roles Participation in QSR System Design Grant requirements for consumer and family input via focus groups, steering committees for design of quality system, applicability in family homes Input on Waiver and Self Direction Guides Regional family forums Consumers and families as trainers of staff Training materials developed by and for consumers Self-advocates & families as NCI interviewers

32. Other Quality System Components Development of a quality Individual Plan for each individual Case Manager and Supervisor oversight of the Plan PRC and HRC Committees Medication Administration Regulations Incident and Abuse / Neglect Reporting and Follow-up Mortality Reviews Regional Quality Visits Contract Administration and Monitoring Licensing NCI Surveys Complaints and PARS Financial Audits

33. Data Base Features

34. Data Base Features

35. My QSR Dashboard View

36. Internal Notification Inbox

37. Locate Consumers & Vendors

38. Sample Review Screen

39. Report Summary Page

40. Follow Up Plan

42. Contact information:Mary.mckay@po.state.ct.usBeth.mcarthur@po.state.ct.us