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Quality Improvement Strategy

Quality Improvement Strategy. Context for the Focus on Quality. Began with the growth & expansion of HCBS waiver programs Growth in expenditures Growth in people served Growth in consumer direction Self Direction presents challenges for assuring quality. CMS approach to Quality.

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Quality Improvement Strategy

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  1. Quality Improvement Strategy

  2. Context for the Focus on Quality • Began with the growth & expansion of HCBS waiver programs • Growth in expenditures • Growth in people served • Growth in consumer direction • Self Direction presents challenges for assuring quality

  3. CMS approach to Quality A quality management data driven model with continuous over-sight • Quality elements are designed into the program • Each state has a quality strategy to continually evaluate it’s own performance, to correct deficiencies and make system improvements….which will tell us if • assurances are met • outcomes are achieved • people are satisfied • CMS reviews the effectiveness of the state’s Quality Management Strategy

  4. CMS Quality Framework

  5. Quality Framework Focus Areas • Participant Access Information and referral; intake and eligibility determination; referral; choice • Participant Service Planning Assessment; service plan, implementation & monitoring; respond to changing needs; choice; participant direction • Provider Capacity Licensure and certification; training; provider monitoring • Participant Safeguards Incident management; risk assessment; behavior management; med administration; natural disasters • Rights and Responsibilities Due process; grievance procedures • Outcomes and Satisfaction • System Performance Quality Improvement program; financial management

  6. Quality Framework Processes • Design… build quality in up front • Discovery… look for problems & opportunities for improvement • Remediation… fix problems • Improvement… make improvements

  7. Community First Choice • Establish & maintain a quality assurance system • Incorporate feedback • Monitor the health and well-being of each individual • Provide information about the provisions of quality assurance

  8. Community First Choice • CMS Quality Framework • Build upon existing structure • Develop Quality Outcomes • Consumer Satisfaction

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