DIDD Provider Review Form

1. DIDD Provider Review Form Revision & Instructions May 22 West Region May 23rd Middle Region May 29th East Region

2. How Did We Get Here? The Provider Monthly Review has been a document in which many QA & QRP findings were addressed- adding much more information to the form than required. Each provider’s monthly review contained different information in various formats. Providers felt they were producing a document for other people that was not always useful internally. The Regulatory Relief Task Force proposed changes to the policy and frequency of the monthly review. Commissioner Henry appointed a Focus Group made up of 4 Providers and 2 ISC Agency representatives.

3. The Monthly Review Focus Group The Focus Group appointed by the Commissioner pursued a decrease in the frequency of the review but discovered it must continue monthly to comply with existing regulations. The Focus Group proposed reducing the components of the review, that the form should be useful to Providers and capture information about the people they support in a person centered way. The Focus Group recommended that the review be standardized and proposed a draft Provider Review and instructions.

4. Developed by Providers for Providers Directors of Provider Agencies representing each Region developed the format, questions and the instructions for the new Provider Review. Directors of 2 ISC Agencies assisted in developing the form, instructions, and applying person centered concepts to each question. Provider and ISC representatives made sure the new form would work well with the new ISC Monthly Documentation form and removed questions that required ISCs to track the Provider Review.

5. Implementation & Approval Because the form and instructions were developed by providers, providers have set the standard and expectations for its use. Providers must be familiar with the form and the instructions and be able to implement them at their agency. The form and instructions have been reviewed and approved for use by DIDD Central Office, DIDD-QA and the QRP. Implementation across the State will begin no later than July 1st. The completed monthly reviews for Julyare due by August 20,2012.

6. Change Is Hard Change can be challenging, but it is worth it. We may have developed a routine around how we complete the Monthly Review and the type of information that is included. If the monthly review form includes information that is specific to the outcomes and contains information that focuses on the unique needs of the person, it will be acceptable to QA surveyors and others who evaluate the documentation. When used correctly this form will capture more useful information about the person and provide information that QA & the QRP look for around supports and progress towards outcomes & actions.

7. From This… Matthew’s Story Buffalo River Services is one of the Provider Agencies who piloted the new Provider Review form. Matthew Lineberry is a Program Director with BRS and this was experience piloting the new form. To This

8. If you check “No” in #1, no comment is needed. If you check “Yes” in the Adobe version of this form a blank field will be added for your comments. • Information to include: • Changes to a person’s services. • A change in how the person is supported in an activity. • Something your agency has identified that contributes to the person having a good day or a bad day. • Information for this section may be gathered from: • Daily notes or learning log • Staff observation • Incident reviews and/or risk reviews • Medical documents • Funds management • Family or conservator input Meaningful Content is Important Question #1 Should include information that is new, adds to, or is a significant change to the information about supports and services in the Personal Focus section of the ISP and needs to be captured in an amendment to the ISP.

9. Example for #1 Do Include Do Not Include Examples include what people know about supports, an interest the person has, or something that needs to be recorded in the ISP and shared with all supporters. • Jon likes to help make dinner but if we don’t invite him to join us in the kitchen he won’t initiate the activity and he feels left out. The best way to support Jon is to let him know when it is time to start making dinner and ask him if he wants to help. • Jon doesn’t like to take his morning medication before he has his first cup of coffee. A simple way to avoid conflict is to wait until Jon finishes his coffee before letting him know it is time to take his medicine. Information that would not need to be recorded includes things that don’t affect how supports are provided or doesn’t require an ISP amendment. For example: • Jon is working Monday, Tuesday, Friday instead of Monday, Wednesday Friday. • Jon is spending an extra weekend with his mother next month. • Jon renewed his gym membership for another year. • Jon ordered a subscription to Netflix.

10. Do not record the individual Action Steps or list the number of times/dates an activity was completed. • In the first column record the specific Outcome as stated in the ISP. • In the second column include what was done during the month to achieve the outcome. Include things that were tried, even if they weren’t successful in implementing the Outcome. Identify the things that worked and things that did not work. If your staff learned anything during the implementation of the outcome and would do something differently the next time, share that information here. • In the third column a “No” response doesn’t require a comment. Check “Yes” if there was a barrier to implementing the Outcome. A barrier is something that prevents us from implementing the Outcome. Briefly describe the barrier and anything that your agency has tried to address it. Indicate if further planning is needed to address the barrier in the ISP. Meaningful Content is Important Question #2 Record and report on only the outcomes from B.1. Personal Outcomes and B.2. Supports for Daily Life in the Action Plan section of the ISP that are identified with the service your agency is responsible for providing.

11. Example for #2

12. Documentation about the utilization of services each month is a component of the Performance Measures and is required by CMS and DIDD. We are required to review how services were used to determine if the amount and frequency of a service is adequate to meet the person’s needs, is being delivered as approved and to make sure it is not consistently being under-utilized. Consistent under-utilization may be an indicator that the amount or frequency of a service can be decreased. Meaningful Content is Important Question #3 Enter each type of Residential, Day or PA waiver service your agency is authorized to provide. If the service was not delivered in the amount and frequency authorized in the ISP, check “No” and briefly explain why it wasn’t. A “Yes” response requires no additional comment.

13. Examples for #3

14. This should include new information and/or information that may have been shared with the ISC during regular interactions and contacts in the month being reviewed. • If you check “No” no comment is needed. If you check “Yes” in the Adobe version of this form a blank field will be added for your comments. • Please note, significant health issues that require additional supports, services or changes to the person’s ISP should be reported to the person’s ISC as they happen so that appropriate and timely action can occur. Meaningful Content is Important Question #4 Include significant events, issues, and changes related to the person’s overall health, behavioral or psychiatric status that require action or follow up, changes in how the person is supported, or changes in the ISP should be recorded in this section.

15. Example for #4 Information about medical appointments or health issues that need follow up or require a change in how someone is supported is shared in this section. Do not include information about routine medical appointments, issues that don’t require specific follow up or a change in supports. • Jon broke his foot at the end of March. He was fitted for a cast and is restricted from standing longer than 10 minutes at a time. He is using a shower bench and needs physical assistance when getting in and out of the tub to prevent him from falling. Jon has a follow up appointment with an orthopedist on April 25th. We need to find out if there are things he can do at work while seated. • Jon had increased incidents of sleeplessness in March. He saw his PCP on 3/30/12 and was referred for a sleep study. That appointment is scheduled for May 5th. • Jon saw the podiatrist on 3/12/12 for his quarterly visit and had his toenails trimmed. • Jon had an annual eye exam on 3/15/12. His prescription hasn’t changed and he doesn’t need new glasses. • Jon went to his PCP on 3/30/12 for a flu vaccination. • Jon saw his psychiatrist in March for a quarterly medication review. No changes were made.

16. Guidance & Assistance Each Provider will use the instructions and guidance provided to train and implement the new Provider Review by July 1st . The monthly reviews for July data aredue August 20th. For additional assistance you can contact: Richard Strecker, DIDD Richard.X.Strecker@tn.gov