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MIS OFFICERS (NC FARO) SPRING 2004 CONFERENCE

Provider Monitoring. SB163 Monitoring Rules: Update. Jim Jarrard: Accountability Team, DMH/DD/SAS Shealy Thompson: Quality Management Team, DMH/DD/SAS. MIS OFFICERS (NC FARO) SPRING 2004 CONFERENCE. April 26, 2004. SB163 Monitoring. Outline:. Background Incident System

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MIS OFFICERS (NC FARO) SPRING 2004 CONFERENCE

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  1. Provider Monitoring SB163 Monitoring Rules: Update Jim Jarrard: Accountability Team, DMH/DD/SAS Shealy Thompson: Quality Management Team, DMH/DD/SAS MIS OFFICERS (NC FARO) SPRING 2004 CONFERENCE April 26, 2004

  2. SB163 Monitoring Outline: • Background • Incident System • Complaint Response • Local Monitoring • Reporting and Analysis

  3. SB163 Monitoring Background: • Date Senate Bill (SB) 163 Enacted: October, 2002 • Provisions made Retroactive to: July 1, 2002 • Purpose of SB163: “An act to implement the recommendations of the legislative research commission's study committee on group homes to address licensure issues and the needs of local school administrative units in which group homes for children are located“

  4. SB163 Monitoring Background: • Within the bill was language which is now written into Statute for MH/DD/SA, 122C-111, which reads: “The area authority or county program shall monitor the provision of mental health, developmental disability, and substance abuse services for compliance with the law, which monitoring shall not supercede or duplicate the regulatory authority or functions of agencies of the Department."

  5. SB163 Monitoring Background: • Stakeholder Workgroup advised in the writing of the Temporary Rules: December, 2002 – March, 2003 • Critical Incident Form Workgroup: April, 2003 • Public Hearing: May 7, 2003 • Date Temporary Rules Went into Effect: July 1, 2003 Note: These rules are Secretary Rules (rather than MH/DD/SA Commission rules). That means that the Secretary is responsible for the promulgation of the rules, rather than the MH/DD/SA Commission. Other rules are Commission Rules, and are promulgated by the MH/DD/SA Commission. The SB 163 Monitoring Rules have been sent to the Commission for review and comment.

  6. SB163 Monitoring Background: • Date Permanent Rules published in NC Register: January 2, 2004 • Stakeholder Workgroup advised in writing language to revise the temporary rules: December, 2003 – February, 2004 • Public Hearing: February 4, 2004 • Date Permanent Rules filed with Rules Review Commission: March 22, 2004 • Two workgroups currently functioning to advise operationalizing the 163 MonitoringRules for implementation: July 1, 2004

  7. SB163 Monitoring Background: • Components introduced in the Temporary Rules: • AA/CP required to monitor all MH/DD/SA services within its catchment area. • AA/CP required to receive, resolve, refer or investigate complaints made to the LME regarding the provision of MH/DD/SA services. • AA/CP required to receive and review incident reports, and identify trends based on those reports. • Providers divided into categories for the purpose of differentiating levels and intensity of monitoring.

  8. SB163 Monitoring Background: • Category A – facilities licensed pursuant to G.S. 122C, Article 2, except for hospitals; these include 24-hour residential facilities, day treatment and outpatient services; • Category B - Community-based providers not requiring State Licensure (including, but not limited to CAP-MR/DD service providers, and homes for one adult); • Category C – hospitals, state-operated facilities, nursing homes, adult care homes, family care homes or child care facilities; and • Category D – individuals providing only out-patient or day services and are licensed or certified to practice in the State of North Carolina.

  9. SB163 Monitoring Background: Components of the Permanent Rules that are different from the Temporary Rules: • The Level I, II, and III Incident Descriptions replace the former "Critical Incident" descriptions. • "Quality Indicators" are removed from the rules. • What was formerly called "Routine Monitoring" is now called "Local Monitoring". • Notification Requirements for notifying State agencies prior to monitoring providersare removed. • “May” replaced by “Shall”.

  10. SB163 Monitoring Background: Challenges We’re Working On: • Elimination of Duplication of Effort -- State, AA/CP, Providers – in Local Monitoring and Complaint Investigations. • Establishment of Confidence Levels to assure AA/CP resources directed where they are most needed. • Examination of Statewide Instruments and Tools to assure consistency and focus in Incident Reporting and Local Monitoring needs.

  11. SB163 Monitoring Incident System: Purpose • To safeguard client health / safety & public safety • To identify areas for correction & improvement – provider, local & state levels

  12. SB163 Monitoring Incident System: Challenges • Balancing consumer safety with burden of reporting requirements • Balancing adequate oversight with efficient/effective use of limited resources • Encouraging self-report of negative events

  13. SB163 Monitoring Incident System: Guidelines: • Ask: • “Is it alreadydocumented elsewhere?” • “Is someone else already reviewing it?” • “Is there a reason to report it twice?” • “How will we use it?”

  14. SB163 Monitoring Incident System: Guidelines: • Envision what information the LME needs from the “competent provider” • Develop means of gathering other information when warranted • Consolidate reporting requirements

  15. SB163 Monitoring Incident System: Development Process: • SB163 Rules workgroup (January 2004) • Incident workgroup (April 2004) • Stakeholder review (May 2004)

  16. SB163 Monitoring Incident System: Structure: • Level I - unusual events • Level II - serious events • Level III - critical events

  17. SB163 Monitoring Incident System : Incident Types: • Deaths • Suicidal Behavior • Consumer injuries • Medication errors • Restraint / Seclusion / Isolated Time Out • Abuse / Neglect / Exploitation • Consumer behavior • Suspension / Expulsion • Fire • Search & Seizure

  18. SB163 Monitoring Incident System : Response Process: • Level I • Provider documents & reviews for patterns • Level II • Provider responds to health/safety needs & reports to LME • LME analyzes for monitoring plans & local system issues • Level III • Provider investigates immediately & reports to LME & state • LME, DFS & DMHDDSAS respond as needed & analyze for system problems

  19. SB163 Monitoring Complaint System: Purpose: • To encourage consumer and family empowerment • To ensure a clear, comprehensive complaint process • To supplement other oversight mechanisms

  20. SB163 Monitoring Complaint System: Challenges: • Helping consumers feel safe to voice complaints • Balancing local resolution of problems with state oversight requirements • Facilitating communication among involved agencies

  21. SB163 Monitoring Complaint System: Guidelines: • Encourage education for consumers about voicing complaints • Establish clear process for responding to complaints • Resolve issues informallyand locally when possible • Clarify thresholds to trigger DFS/DMH involvement

  22. SB163 Monitoring Complaint System: LME Policies & Procedures: • Notification procedure • Safeguards to protect complainant & consumer from retaliation • Facilitation of informal discussion & agreement • Options for resolving a complaint • Investigation methods - Category A & B providers

  23. SB163 Monitoring Complaint System: LME Policies & Procedures : • Referral to another agency – • Category C & D providers • Unresolved Category A & B providers • Conflicts of interest • Provider appeal process • Documentation and analysis • Follow-up

  24. SB163 Monitoring Complaint Response: Investigation - Category A & B Providers: • Complete the investigation within 30 days of the complaint. • Report to complainant, provider and the client’s home LME within 10 working days of completing the report. • Ensure correction of problems within 60 days of the report. • Follow-up within 90 days of the report.

  25. SB163 Monitoring Complaint Response: Referral - All Providers: • Inform complainant and provider of the referral • Follow-up within 120 days to determine outcome • Ensure that the complainant, provider, and client’s home LME know the outcome

  26. SB163 Monitoring Local Monitoring: Written Policies and Procedures, addressing: • The frequency and extent of local monitoring. • The referral of local monitoring of a Category A provider to DFS or a Category B provider to DMH/DD/SAS. • The appeal of the results of local monitoring.

  27. SB163 Monitoring Local Monitoring: The frequency and extent of local monitoring based on: • Number and severity of level II/level III incidents reported by the provider, and the provider’s response to the incidents. • Provider’s compliance with the reporting requirements. • Number and types of complaints received concerning a provider, and the provider’s response to the complaints.

  28. SB163 Monitoring Local Monitoring: The frequency and extent of local monitoring based on: • Conclusions reached from complaint investigations. • Results of reviews conducted by DFS, DMH/DD/SAS or DSS; • Compliance with the requirements of the provision of public services. • Addition of a new service. • National accreditation (COA, JCAHO, Council on Quality and Leadership.

  29. SB163 Monitoring Local Monitoring: Referral of Local Monitoring to appropriate State agency, based on: • Local monitoring identifies an issue a State agency is required to review; • Plan of correction resulting from local monitoring is not submitted to the area authority or county program within the designated timeframe; • Issues identified in a local monitoring report are not corrected by the provider; • Area authority or county program is the provider of the service to be monitored; and • Appeal of the results of local monitoring.

  30. SB163 Monitoring Local Monitoring: Specified AA/CP Requirements: • Communicate results of Local Monitoring to provider within ten (10) days, including: • Identification of each service monitored. • Identification of any issues requiring correction. • Timelines for implementing the corrections (not to exceed 60 days from the date the provider receives the local monitoring report)

  31. SB163 Monitoring Local Monitoring: Specified AA/CP Requirements: • Provide a copy of the local monitoring report to the client’s home area authority or county program (if different) upon request, within ten (10) days of completion • Submit report of local monitoring activities to State not less than monthly, including: • identification information for providers monitored during the reporting period. • whether issues requiring correction were identified. • an explanation of any uncorrected issues.

  32. SB163 Monitoring Reporting and Analysis: Purpose: • To ensure consumer health, safety and rights protection. • To improve the quality of services • To guide consumers’ choice of providers • To give stakeholders and the public confidence in the MH/DD/SAS system • To support requests for funding

  33. SB163 Monitoring Reporting and Analysis: Trend Analysis: • Patterns across groups – Ask “Why is this occurring here and not elsewhere?” • Patterns over time • Worsening – Ask “How can we reverse this trend?” • Improving – Ask “How can we celebrate this success and replicate it elsewhere?”

  34. SB163 Monitoring Reporting and Analysis: Root Cause Analysis: • Occurs at all levels of the service system • Look for system issues, not persons to blame • Ask “Why?” and when answered, continue to ask “Why?” – again and again • Ask “How can we change our policies, procedures and/or structures to remedy this problem and prevent its reoccurrence?”

  35. SB163 Monitoring Reporting and Analysis: Provider Reports: • Level I Incidents – quarterly aggregate reports to LME • Level II Incidents – individual reports to LME(s) • Level III Incidents – individual reports to LME(s), DFS, & DMHDDSAS • Other reports required by contract or monitoring

  36. SB163 Monitoring Reporting and Analysis: LME Reports: • Monthly Provider Monitoring Reports • Quarterly Trend Reports Send both to: ContactDMHQuality@ncmail.net

  37. SB163 Monitoring Reporting and Analysis: DMH/DD/SAS Reports: • Quarterly Incident Trend Reports • System Performance Reports • Annual Legislative Report • Suggestions? Available at: http://www.dhhs.state.nc.us/mhddsas/manuals/index.htm

  38. Provider Monitoring SB163 Monitoring Rules: Update Contacts • DMH/DD/SAS Accountability Team (919) 881-2446 • DMH/DD/SAS Quality Management Team (919) 733-0696

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